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Pediatrics > Peds deck 4 > Flashcards

Peds deck 4 Flashcards

1
Q

the chest wall, trachea and the bronci are highly _______________ compared to the adult

A

compliant

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2
Q

what happens in normal expiration in the child

A

slightly negative intrathoracic pressure (less than on inspiration) –> maintaning of patency of intrathoracic trachea and bronchi

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3
Q

in normal inspiration in the child, what happens?

A

increased negative intrathoracic pressure –> dilation and stretching of intrathoracic trachea and bronchi & dynamic collapse of extrathoracic trachea

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4
Q

extrathoracic airway obstruction, what is the result in a child?

A
  1. even greater collapse of extrathoracic trachea below obstruction 2. more negative intrathoracic pressure –> greater dilation of intrathoracic trachea and bronchi
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5
Q

extrathoracic airway obstruction is characterized by what lung sounds?

A

stridor

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6
Q

intrathoracic airway obstruction is characterized by what lung sound

A

prolonged expiration or wheeze

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7
Q

how do the dynamics of the airway change with intrathoracic airway obstruction

A
  1. highly increased intrathoracic pressure –> dynamic collapse of intrathoracic airway
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8
Q

what may cause extrathoracic airway obstruction?

A
  1. epiglottitis 2. larngotracheobronchitis 3. extrathoracic foreign body
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9
Q

intrathoracic airway obstruction causes

A

1.asthma 2. bronchiolitis 3. inhaled foreign body

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10
Q

the ribs of the chest wall are in a more _____________ orientation compared to an adult

A

horizontal

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11
Q

by what age are the orientation of the ribs comprising the chest wall similar to that of the adult

A

10

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12
Q

children having a more horizontally oriented chest wall (due to ribs) predisposes them to ?

A
  1. respiratory failure 2. lung injury 3. ventilation associated lung injury
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13
Q

inspiration of the infant depends almost exclusively on __________________

A

the descent of the diaphragm

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14
Q

as work of breathing in the infant increases the _______________ must also increase to maintain tidal volume –> quick fatigue and respiratory distress

A

diaphragmatic descent

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15
Q

when at rest expirations in infant are _____________

A

passive

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16
Q

infants have ______________ pulmonary compliance and _____________ static recoid

A

high; low

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17
Q

_______________ is the principle factor which determines lung compliance

A

volume

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18
Q

pulmonary lung compliance is ______________ infants

A

high

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19
Q

static lung compliance

A

change in volume for any change in pressure

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20
Q

dynamic lung compliance

A

compliance of lung at any given time during air exchange

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21
Q

clinical implications of infants having high lung compliance and low static recoil

A
  1. decreased recoil –> increased possibility of lung collapse with dz 2. excessive lung compliance of the infant = more work to maintain adequate tidal volume 3. during respiratory distress –> diaphragm fatigues –> apnea
22
Q

infants have a __________ FRC to TLC ratio

A

low; limits gas excahnge

23
Q

under general anesthesia the infants FRC may only be __________% of the TLC

A

10-15 (normally closer to 30-40%)

24
Q

TLC in the pediatric pt is ____________ than that compared to an adult

A

less

25
Q

what static lung volumes are linearly related to the log of height

A

TLC, VC, FRC, and RV

26
Q

why is TLC in the infant so much smaller than in the adult?

A

it is effort dependent which is related to the strength of the inspiratory muscles (estimated by maximum inspiratory pressure at FRC) and the ability to generate negative pressure

27
Q

_______________ flow is present in the peripheral bronchi and bronchiole

A

laminar

28
Q

_____________ flow is present in the upper and lower conducting airways

A

turbulent

29
Q

what law determines airway flow/pressures with airway obstruction/edema

A

poiseuilles

30
Q

T/F: periodic breathing in neonates is common

A

TRUE

31
Q

what defines periodic breathing in infants

A

apneic spells < 10 seconds without cyanosis or bradycardia

32
Q

incidence of periodic breathing in: Premies = ___________ neonates = ___________ 1 year of age = ___________

A

100%; 80%; 30%

33
Q

define central apnea

A

apnea > 15 seconds accompanied by cyanosis, bradycardia (<100 bpm) and/or pallor

34
Q

what is the most common risk factor for central apnea

A

prematurity

35
Q

T/F: newborn paO2 is lower than the adult

A

TRUE

36
Q

the lower PaO2 in the newborn is compensated for by ________________

A

presence of fetal hgb

37
Q

P50 in the neonate

A

left shift (~19)

38
Q

during the _______________ week of life, the oxy-hgb dissociation curve of the newborn begins to switch to the left, reflecting the transition of _______________

A

first; fetal to adult hgb

39
Q

pH, PaO2, and PaCO2 are all ____________ in the newborn

A

lower

40
Q

what type of ABG would you expect the newborn

A
  1. metabolic acidosis 2. increased lactate 7.3-7.4/30-35/60-90/<22
41
Q

why is there metabolic acidosis in the newborn

A

reduced pH, and increased volume of distribution causes a dilution of bicarb

42
Q

how do infants increase their alveolar ventilation

A

by increasing RR (NOT Tv)

43
Q

metabolism in the infant is _____________

A

higher

44
Q

O2 consumption and CO2 production is ______________ in the infant

A

higher

45
Q

O2 consumption is _______x that of the adult, which leads to doubling _______________ on a per kg basis

A

2; alveolar ventilation

46
Q

what increases the risk of laryngospasm in peds

A
  1. upper respiratory infection 2. reactive airway dz 3. passive environmental smoke 4. inadequate anesthetic depth
47
Q

T/F: laryngospasm is an anesthetic emergency

A

TRUE

48
Q

how do you treat a laryngospasm

A
  1. jaw thrust 2. positive pressure 3. lidocaine 4. succinylcholine (1 mg/kg)
49
Q

incidence of bronchospasm in peds

A

0.40%

50
Q

what increases the risk of bronchospasm in pediatrics

A
  1. upper respiratory infection 2. reactive airway dz 3. inadequate anesthetic depth 4. too deep of endotracheal tube placement 5. CF and BPD

Pediatrics (15 decks)

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