Peds deck 4

Question 1

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

Answer 1

compliant

Question 2

what happens in normal expiration in the child

Answer 2

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

Question 3

in normal inspiration in the child, what happens?

Answer 3

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

Question 4

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

Answer 4

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

Question 5

extrathoracic airway obstruction is characterized by what lung sounds?

Answer 5

stridor

Question 6

intrathoracic airway obstruction is characterized by what lung sound

Answer 6

prolonged expiration or wheeze

Question 7

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

Answer 7

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

Question 8

what may cause extrathoracic airway obstruction?

Answer 8

1. epiglottitis 2. larngotracheobronchitis 3. extrathoracic foreign body

Question 9

intrathoracic airway obstruction causes

Answer 9

1.asthma 2. bronchiolitis 3. inhaled foreign body

Question 10

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

Answer 10

horizontal

Question 11

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

Answer 11

10

Question 12

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

Answer 12

1. respiratory failure 2. lung injury 3. ventilation associated lung injury

Question 13

inspiration of the infant depends almost exclusively on __________________

Answer 13

the descent of the diaphragm

Question 14

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

Answer 14

diaphragmatic descent

Question 15

when at rest expirations in infant are _____________

Answer 15

passive

Question 16

infants have ______________ pulmonary compliance and _____________ static recoid

Answer 16

high; low

Question 17

_______________ is the principle factor which determines lung compliance

Answer 17

volume

Question 18

pulmonary lung compliance is ______________ infants

Answer 18

high

Question 19

static lung compliance

Answer 19

change in volume for any change in pressure

Question 20

dynamic lung compliance

Answer 20

compliance of lung at any given time during air exchange

Question 21

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

Answer 21

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

Question 22

infants have a __________ FRC to TLC ratio

Answer 22

low; limits gas excahnge

Question 23

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

Answer 23

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

Question 24

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

Answer 24

less

Question 25

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

Answer 25

TLC, VC, FRC, and RV

Question 26

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

Answer 26

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

Question 27

_______________ flow is present in the peripheral bronchi and bronchiole

Answer 27

laminar

Question 28

_____________ flow is present in the upper and lower conducting airways

Answer 28

turbulent

Question 29

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

Answer 29

poiseuilles

Question 30

T/F: periodic breathing in neonates is common

Answer 30

TRUE

Question 31

what defines periodic breathing in infants

Answer 31

apneic spells < 10 seconds without cyanosis or bradycardia

Question 32

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

Answer 32

100%; 80%; 30%

Question 33

define central apnea

Answer 33

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

Question 34

what is the most common risk factor for central apnea

Answer 34

prematurity

Question 35

T/F: newborn paO2 is lower than the adult

Answer 35

TRUE

Question 36

the lower PaO2 in the newborn is compensated for by ________________

Answer 36

presence of fetal hgb

Question 37

P50 in the neonate

Answer 37

left shift (~19)

Question 38

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

Answer 38

first; fetal to adult hgb

Question 39

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

Answer 39

lower

Question 40

what type of ABG would you expect the newborn

Answer 40

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

Question 41

why is there metabolic acidosis in the newborn

Answer 41

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

Question 42

how do infants increase their alveolar ventilation

Answer 42

by increasing RR (NOT Tv)

Question 43

metabolism in the infant is _____________

Answer 43

higher

Question 44

O2 consumption and CO2 production is ______________ in the infant

Answer 44

higher

Question 45

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

Answer 45

2; alveolar ventilation

Question 46

what increases the risk of laryngospasm in peds

Answer 46

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

Question 47

T/F: laryngospasm is an anesthetic emergency

Answer 47

TRUE

Question 48

how do you treat a laryngospasm

Answer 48

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

Question 49

incidence of bronchospasm in peds

Answer 49

0.40%

Question 50

what increases the risk of bronchospasm in pediatrics

Answer 50

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