Peds A+P Dan Miller Style!!! Flashcards
Ages for Peds: New Born? Infant? Toddler? Preschooler? School age? Adolescent
Newborn -> 0-1 month Infant -> 1-12 months Toddler -> 1-3 yrs Preschool -> 4-6 yrs School -> 6-13 yrs Adolescent -> 13-18 yrs
Fetal Circulation
What should close in the fetus after delivery
Foramen Ovale
Ductus Arteriosus
Ductus Venosus
Why do these fetal heart changes take place
Pressure changes in the circulatory system
- Reduction of pulmonary vascular resistance
- Elevation of systemic vascular resistance
3 things stimulate the New born to take its first breath what are they??
Hypoxia, acidosis, sensory stimulation
Taking the first breath facilitates what in the Pulmonary vasculature?
Increases arterial and aveolar oxygen tension which helps reduce pulmonary vascular resistance
Why does the Foramen Ovale close
decreased right atrial pressure
increase SVR
removal of placental prostaglandins
Why dose the Ductus arteriosus close
PVR and SVR pressure changes
removal of placental prostaglandins
Why dose the Ductus Venosus close
Factors causing Persistant Pulmonary HTN
Hypoxemia
acidosis
hypothermia
preterm
meconium aspiration
congenital diaphramatic hernia
Persistant Pulmonary HTN
Treatement for Persistant Pulm. HTN
Nitric oxide inhalation
New borns brath through their nose or mouth
obligate nasal breathers
Gross anatomy differences from adults
large epiglotis
large tongue
large occiput
short neck
What is the narrowest point in the new born airway
cricoid cartilage
Cricoid is shaped like a ???
funnel
cuffed or uncuffed tubes
uncuffed and should hear a leak at 20-25 cm H2O
Newborns till age 5 have proportionally smaller distal airways, this causes
Increase work of breathing
Respiratory physiology for a Newborn
Increased O2 consumption
increased metabolic rate
increased aveolar ventilation
increased ventilatory rate
Decreased FRC
Infants have a increased closing capacity, this means??
Why are SNS and baroreceptors blunted in the infant
Immature and this causes a blunted response to EPI and ephedrine as well as endogenous catacholamines
Is the parasympathetic NS fully developed??
YES at birth and controlled HR in utero
Neonate/ Newborn cardiac out is mainly dependant upon
HR Neonate
160’s
HR and BP Newborn
120’s
60ish Systolic
Fetal Hemoglobin is special why?
higher affinity for O2
Fetal Hgb causes a R or L shift in the curve??
Fetal Hgb also causes and increase in ??
2,3-DPG
What causes the newborn to produce adult Hgb at about 2-3 months
The life cycle of the Fetal Hgb
The spinal cord ends where in pediatrics??
L3
the dominant Nervous system in newborns is PNS or SNS
PNS
GFR normalizes at what age
1yr old
Decreased GFR in children under one is because
Low SBP
increased renal vascular resistance
decreased glomerular capillary permeability
Peds begin to concerntrate urine at age
2-3 yrs
Ped liver function
Hyperbilirubinemia
excessive breakdown of billirubin and impeded excreation
Hyperbilirubinemia is most common in these infants
Preterm and breast fed
what it kernicterus
Gerd is seen in what % of newborns for the 1st week of life??
50 %
GERD in the infant is due to
Decreased LES tone
Meconium aspiration can cause
pneumonia
pneumothorax
PPHTN
how do neonates increase their temp
nonshivering thermogenesis
Brown fat Metabolism
4 reasons for neonates / newborns to regulate temp
Immature ANS
thin skin
reduced adipose tissue
increased BSA
Heat loss can be by
radiation
conduction
convection
evaporation
Where are the 4 areas of BROWN FAT, YA BROWN FAT??
between scapulas, axillae, mediastinum, surrounding kidneys
Whats special about BROWN FAT
high concerntration of mitochondria
Calculating rough weight
(2 x the age) +9 = kg
why do neonates and newborns need more medication??
total body water content is 75% which causes a greater volume of distribution therefore less effect
% things to keep in mind when dosing meds for a newborn
Decreased liver function
Decreased Plasma binding
Decreased GFR
Decreased enzymatic metabolism
immaturity of the BBB
2 proteins that are decreased in the neonate
Albumin and
Enzymatic metabolism is done 2 ways
Cytochrome P450
Rectal routes of medication have 3 vascular pathways??
Injection sites for meds
vastus lateralis (infants - small children)
Deltoid (older children)
Volumes of injection
Newborn IV sites
Is MAC higher or lower in infants then adults
higher and trends down as they reach adults
Peds dose of propofol
2-3 mg /kg
Peds dose of ketamine
1-2 mg/kg
Propofol infusion should NEVER be continued into ICU because of
Propofol infusion syndrome
SX of propofol infusion syndrome??
Percitipating factors for propofol infusion syndrome
> 48 hr infusion
> 5 mg/kg/hr
why will you see an increased response to volital agnets in newborns
immature ANS
Volital agent induction recmmendation is
Sevo- least cardiac depressive, nonpungent, fast induction, fast emergence
If maintaince is longer than an hour switch to ISO after induction.
drugs of choice for pain control
can you mix your reversal agents??
which agent do you give first in reversals
anticholenergic
Which drug do you give second in reversal
why do you anticholenesterase ONLY AND I MEAN ONLY give the anticholinesterase after you have an increse in HR
ONLY 2 reasons to give sucs in Peds??
laryngospasm and airway emergency
Why do you not give sucs to Peds
why should you be careful in fluid administration with peds
Types of fluid administered for maintainance
Hourly fluid for < 10 kg
4 ml/kg
OR
100ml/kg in 24 hours
Fluid maintenance for 11-20 kg
Fluid maintence for >20 kg
Blood loss replacement
