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Principles 2 > Peds (Blue stuff only) > Flashcards

Peds (Blue stuff only) Flashcards

1
Q

How old is Premature?

A

Less than 37 weeks gestation or less than 2,500 g

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2
Q

How old is a Neonate?

A

0-1 month

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3
Q

How old is an infant?

A

1 month - 1 year

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4
Q

How old is a Toddler?

A

1 year - 3 years

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5
Q

How old is a Small Child?

A

4-6 years

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6
Q

How old is a Big child?

A

6-12 years

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7
Q

How old is an Adolescent?

A

13-18 years

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8
Q

What is the difference between a pediatric and adult airway?

A

-Cartilage isn’t calcified = easier to collapse w/loss of muscle tone
-Large tongue & occiput (difficult to achieve sniffing position)
-Larynx is higher than in adults (C2-C4 compared to C3-C6). More cephalad = difficult DL
-Epiglottis is Omega-Shaped and stiff
-Narrowest point of the airway = cricoid cartilage (adults is vc).

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9
Q

What are the differences in pediatric respiratory physiology?

A

-Airway resistance is greater due to smaller diameter
-Inc WOB
-Immature CNS: Apnea/irregular breathing patterns are normal
-Use smaller cuffs to avoid swelling/pressure (can have glottic narrowing simply because of prolonged intubation)
-Chest wall is very compliant (ribs not calcified yet)
-Alveolar compliance is low (limited O2 reserve - important during induction)
-Smaller residual lung volumes
-High risk of apnea in the preterm neonate <60 wks PCA
-Increased O2 consumption compared to adults

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10
Q

Infants < ____ weeks PCA should be monitored with a min of pulse ox overnight after general and neuraxial anesthesia.
-Due to high risk of apnea.
-Big concern with preemies.

A

< 60 weeks Post-Conceptual Age (PCA)

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11
Q

What type of muscle fibers are the diaphragm and intercostals in peds? Why is this important?

A

-They are type 2 fibers: built for short bursts of activity and fatigue rapidly.
-Don’t mature until 2 years of age
-Any factor that increases WOB leads to early fatigue of the respiratory system

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12
Q

What are considerations regarding a patient with Trisomy 21?

A

-Atlanto - occipital instability (underdeveloped ligaments - be gentle with head positioning)
-Chronic URIs (inc airway reactivity)
-Large tongue
-Small oral cavity

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13
Q

What are the differences with the pediatric Cardiovascular physiology?

A

-O2 consumption is 2x that of adults (7 mL/kg/min vs 3.5 mL/kg/min)
-CO is HR dependent (hypoxemia may precipitate bradycardia -very bad in peds)
-Vagal stimulation = marked bradycardia (can pretreat with anticholinergic like glyco or atropine)
-Increases susceptibility to myocardial depression by inhaled drugs (due to calcium channel blocking activity)

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14
Q

What is unique about Fetal Hemoglobin?

A

It has a higher affinity for O2 than adult hgb.
-Compensatory mechanism for low PaO2 in fetal circulation (fetus was getting O2 from mom via placenta)
-Fetal Hgb shifts curve to the left with a lower P50
-Increased 2,3 DPG corrects this by shifting it to the right.
-Support neonatal Hgb levels to avoid tissue hypoxia
-Levels stabilize at 2-3 months old

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15
Q

What are the differences with pediatric fluid/electrolyte balances?

A

-Larger total body water percentage (TBW is 75-80% compared to adults at 60%)
-Newborn ECF is 40% of their body weight
-Neonates are unable to conserve Na

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16
Q

What is the Estimated Blood Volume range for a Premature infant?

A

90-100 mL/kg

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17
Q

What is the Estimated Blood Volume range for a newborn (term)? (0 - 30 days)

A

80-90 mL/kg

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18
Q

What is the Estimated Blood Volume range for an infant? (30 days - 2 years)

A

75-80 mL/kg

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19
Q

What is the Estimated Blood Volume range for a School aged Child? (3-18 years)

A

75 mL/kg

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20
Q

What is the Estimated Blood Volume range for an Adult?

A

65-70 mL/kg

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21
Q

How do pediatrics perform thermoregulation?

A

-Thermoregulation is compromised because of a lack of the ability to shiver.
-They metabolize brown fat, cry, and move their extremities.
-Lose heat rapidly through conduction, radiation, and convection

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22
Q

What are the differences in the pediatric nervous system?

A

-Spinal cord ends at L3 instead of L1.
-Fontanelles are not fused (monitor for volume status)
-Blood brain barrier is incomplete.
-Myelination begins during the fetal period and extends progressively. It does not reach maturity until the age of 2-3.

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23
Q

What happens with peds because the BB Barrier is incomplete?

A

This is an important consideration in drugs that may not cross the blood brain barrier in adults, but will in pediatrics.

24
Q

How many mg/kg/min of glucose does an infant require?

A

3-4 mg/kg/min

25
Q

How many mg/kg/min of glucose does a neonate require?

A

5-6 mg/kg/min

26
Q

How do you calculate the hourly glucose replacement for a 2 kg neonate?

A

2 kg neonate requires 5 mg/kg/min equals 10 mg/min= 600mg/hr
-D5% = 50 mg of dextrose per 1 mL

600mg/hr / 50mg/mL = 12mL/hr

27
Q

What is unique about Pediatric Pharmacokinetics?

A

-Increased total body water affects the volume of distribution of drugs as compared to adults
-CNS effects of opioids and barbiturates may be prolonged because of the immature blood-brain barrier.
-Very sensitive to opioid respiratory depression (even more so if <60 wks PCA)

28
Q

MAC is higher in infants from ____ to ____ months, peaking at ____ months.

A

MAC is higher in infants from one to six months, peaking at 3 months.
-Due to immature BB Barrier
-At around 6 months, it comes back down and starts to represent adult-ish values.
-Has a second increase in puberty (but not as much).

29
Q

What is important to know regarding Succinylcholine in peds?

A

-Larger volume of distribution requires more per KG in children than adults
-Often avoided unless clinically indicated for a rapid sequence induction because of reported cases of unanticipated cardiac arrest (Dystrophy can precipitate untreatable hyperkalemia)

30
Q

What is the weight based fluid calculation rule?

A

4 mL/kg for the first 10 kg
2 mL/kg for 10 - 20 kg
1 mL/kg for any remaining kgs over 20 kg

31
Q

How much fluid replacement does a kid need who is 30 kg?

A

70 mL/hr of maintenance fluids

32
Q

What is the fluid replacement for third spacing for Minor Surgery?

A

2-4 mL/kg/hr
Ex: Herniorrhaphy, clubfoot

33
Q

What is the fluid replacement for third spacing for Moderate Surgery?

A

4-8 mL/kg/hr
Ex: Pyloromyotomy

34
Q

What is the fluid replacement for third spacing for Major Surgery?

A

8-10 mL/kg/hr
Ex: Bowel resection, NEC

35
Q

What is the equation for Allowable Blood Loss?

A

EBV x (Starting Hct - Target Hct) / Starting Hct

36
Q

What is usually the lowest allowable Hgb/Hct for peds?

A

Hct of 30% or Hgb of 10, but should be patient specific

37
Q

What is the initial fluid bolus rate for mild to moderate hypotension?

A

10-20 mL/kg of 5% Albumin or LR

38
Q

Abstain for __ hours after a Heavy Meal before any anesthetic (fatty foods)

A

8 hours

39
Q

Abstain for __ hours after a Light Meal before any anesthetic (toast and clears)

A

6 hours

40
Q

Abstain for __ hours after Formula/Non-human milk before any anesthetic

A

6 hours

41
Q

Abstain for __ hours after breast milk before any anesthetic

A

4 hours

42
Q

Abstain for __ hours after Clear Liquids before any anesthetic

A

2 hours

43
Q

What is the formula for estimating weight in kg based on age?

A

(Age x 2) + 9
-For ages 2-9 years

44
Q

What is the ETT size (uncuffed) for a Preemie (<2.5 kg)?

A

2.5 to 3.0

45
Q

What is the ETT size (uncuffed) for a Term Newborn?

A

3 to 3.5

46
Q

What is the ETT size (uncuffed) for an Infant (3 months - 1 year)?

A

3.5 to 4

47
Q

What is the ETT size (uncuffed) for a 2 year old?

A

4.5 (4 cuffed)

48
Q

How do you determine the size of a CUFFED ETT for a patient aged > 1?

A

Reduce size by 0.5 mm.

49
Q

How do you estimate ETT size for patient aged > 4 years old?

A

(age / 4) + 4
-Uncuffed tube size

50
Q

What is the formula for estimating ETT depth (Age > 4 years old)?

A

3 times the ETT size or Age + 10 cm

51
Q

What are the doses of Epinephrine for peds emergency?

A

-Epi 1 mcg/mL if less than 10 kg
-Vasopressor Dose: 2-10 mcg/kg
-Arrest Dose: 30 mcg/kg

52
Q

What are the doses of Atropine for peds emergency?

A

0.02 - 0.04 mg/kg IM
0.02 mg/kg IV

53
Q

What are the doses of Succinylcholine for peds emergency?

A

4 mg/kg IM
2 mg/kg IV

54
Q

How do you prep your emergency drugs (in general) for peds cases)

A

-If the calculated weight-based doses involve giving less than ONE milliliter of a drug, the drug should be drawn up in a TB syringe.
-These drugs should be available with 21 gauge needles(**) on the syringe in case they have to be given IM prior to establishing IV access or in the event that IV access is lost

55
Q

Describe the process of a basic Inhalation Induction.

A

1) Patient enters room. Place pulse ox
2) Child breathes in via mask 70% Nitrous and 30% O2
3) Gradually increase Sevo up to 8%
4) Patient is less responsive, lay flat and apply precordial, NIBP, and ECG
5) Other team member looks for IV while you manage airway
6) Shut off Nitrous, go to 100% O2, and decrease Sevo to 4-6%
7) Once IV established, give Fentanyl & Propofol
8) Establish airway, confirm bilat breath sounds
-Want a leak at ETT/glottic opening at 20 cmH2O (concern for causing pressure)
9) Tape ETT, listen again

Principles 2 (45 decks)

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