Peds deck 5 Flashcards
how do you treat bronchospasm
- albuterol via MDI or nebulizer (2.5 mg 10 kg) 2. increased PPV 3. increased volatile agent 4. propofol 5. steroids 6. epinephrine
what can cause post-extubation croup
- edema 2. too large of ETT 3. repeated laryngoscopy attempts 4. URI 5. positioning - particuallry if proned 6. surgical duration
how do you tx post-extubation croup
- steroids 2. 2.25% nebulized racemic epi (0.05 mL/kg) 3. supplemental O2 as needed
tx for apnea in the infant
- stimulation 2. medications - naloxone or doxapram
dose of naloxone in peds
5-10 mcg/kg (larger doses may be needed)
dose of doxapram in peds
1 mg/kg
hypoxemia is _____________ related to age in peds
inversely (thus hypoxemia risk is increased the younger they are)
if pt comes in with tongue hanging out, drooling, fever, cyanosis what should you do
is an emergency pt needs to go to OR immediately; contact ENT and airway will be handled in the OR (most likely tracheotomy)
anesthesia considerations for pt with foreign body in airway
- calm the pt 2. allow them to spontaneous ventilate 3. NO PPV
what is considered airway emergencies in peds
- epiglottitis 2. foreign body 3. inhalational burn
what are some of the challenges with masking in pediatrics
- finger placement - easy for finger to move from mandible and into submental triangle –> occlusion 2. larger the tongue the harder to bag 3. you need a seal bc the INH agent is on 4. very challenging with babies
in masking an infant how should you position their head for masking?
no change typically they are already in a natural sniffing position
if you are using an OPA on induction, when would be the best time to place it
not until you have an IV bc OPA will increase risk of laryngospasm
if you are going to use OPA on emergence, when should you place it?
when they are still deep enough not to cough or gag on it
sizing OPA
corner of mouth to angle of jaw
sizing NPA
nare to angle of mandible
why are NPA commonly avoided in peds
to avoid trauma and bleeding with hypertrophic adenoids/swollen turbinates
how would you position an infant for intubation? what if they had hydrocephalus?
NAME?
how would you position an older child (12 years of age) for intubation
pillow under head (typically after 6 years of age)
ETT depth for 1 kg
7 cm
ETT depth for 2 kg
8 cm
ETT depth for pt who is 3 kg
9 cm
ETT depth for pt who is 4 kg
10 cm
ETT depth for 1 year old
11 cm
ETT depth for 2 year old
12 cm
ETT depth for child > 2 years of age
12 + age/2
T/F: awake tracheal intubations are common in peds
FALSE
size of ETT in pt weighing less than 1 kg 1. cuffed ____________ 2. uncuffed ___________
- cuffed - N/A 2. uncuffed = 2 - 2.5 mm
size of ETT in 1-2.5 kg pt 1. cuffed = __________ 2. uncuffed = ____________
- cuffed = N/A 2. uncuffed = 2.5 - 3.0
size of ETT in neonate - 6 mo old 1. cuffed = ____________ 2. uncuffed = ____________
- cuffed = 3 2. uncuffed = 3 - 3.5
size of ETT in 6 mo - 18 mo old 1. cuffed = _____________ 2. uncuffed = _______________
- cuffed = 3.5 2. uncuffed = 4
size ETT in 18 mo - 2 year old 1. cuffed = ______________ 2. uncuffed = ____________
- cuffed = 4 2. uncuffed = 4.5
formula for size of uncuffed ETT in children > 2 years of age
(age + 16)/4
formula for size of cuffed ETT in children > 2 years of age
[(age + 16)/4] - 1/2 size
what is the disadvantage of straight laryngoscope blades for peds
they can injure the epiglottis
what was the theory behind using uncuffed ETT in children < 8 years of age
had decreased pressure on internal cricoid cartilage, thus caused less mucosal damage and decreased risk of post-extubation croup
disadvantages to uncuffed ETT
- increased risk of repeated DL d/t incorrect sizing –> edema 2. leak –> wase of INH agent 3. changes in surgery dynamic (peritoneal insufflation) may drastically change leak status 4. paralysis can lead to greater relaxation and increased leak
all cuffed ETTs in todays time are ____________ volume ___________ pressure
higher; lower
what is a risk of prolonged intubation with cuffed ETT, esp in pre-term neonates
acquired subglottic stenosis
what is the pathogenesis of acquired subglottic stenosis
there is ischemic injury to lateral wall pressure from ETT –> edema and narrowing of subglottic area
advantages to cuffed ETT in peds
- less DL 2. better seal, which can be changed through the case if needed 3. decreased risk of aspiration
typically you would go down __________ size from uncuffed for a cuffed ETT
2-Jan
if you have placed a cuffed ETT, and are using N2O for the case, what should you be cautious of?
if long case, N2O can cause the cuff to expand –> so check cuff pressures
advantage of LMA
- frees up providers hands 2. less room pollution 3. can use with vent 4. can pull deep or awake 5. great for children at risk for bronchial airway reactivity
why should LMA still be cautioned in children with recent URI
because risk for laryngospasm is still so high
what is the estimated blood volume in a preterm infant
100 mL/kg
what is the estimated blood volume in a term infant
90 mL/kg
what is the estimated blood volume in an infant
80 mL/kg
what is the estimated blood volume in school aged child
70-75 mL/kg
what is the estimated blood volume in an adult
70 mL/kg
