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Pediatrics > Peds deck 5 > Flashcards

Peds deck 5 Flashcards

1
Q

how do you treat bronchospasm

A
  1. albuterol via MDI or nebulizer (2.5 mg 10 kg) 2. increased PPV 3. increased volatile agent 4. propofol 5. steroids 6. epinephrine
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2
Q

what can cause post-extubation croup

A
  1. edema 2. too large of ETT 3. repeated laryngoscopy attempts 4. URI 5. positioning - particuallry if proned 6. surgical duration
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3
Q

how do you tx post-extubation croup

A
  1. steroids 2. 2.25% nebulized racemic epi (0.05 mL/kg) 3. supplemental O2 as needed
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4
Q

tx for apnea in the infant

A
  1. stimulation 2. medications - naloxone or doxapram
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5
Q

dose of naloxone in peds

A

5-10 mcg/kg (larger doses may be needed)

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6
Q

dose of doxapram in peds

A

1 mg/kg

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7
Q

hypoxemia is _____________ related to age in peds

A

inversely (thus hypoxemia risk is increased the younger they are)

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8
Q

if pt comes in with tongue hanging out, drooling, fever, cyanosis what should you do

A

is an emergency pt needs to go to OR immediately; contact ENT and airway will be handled in the OR (most likely tracheotomy)

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9
Q

anesthesia considerations for pt with foreign body in airway

A
  1. calm the pt 2. allow them to spontaneous ventilate 3. NO PPV
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10
Q

what is considered airway emergencies in peds

A
  1. epiglottitis 2. foreign body 3. inhalational burn
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11
Q

what are some of the challenges with masking in pediatrics

A
  1. 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
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12
Q

in masking an infant how should you position their head for masking?

A

no change typically they are already in a natural sniffing position

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13
Q

if you are using an OPA on induction, when would be the best time to place it

A

not until you have an IV bc OPA will increase risk of laryngospasm

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14
Q

if you are going to use OPA on emergence, when should you place it?

A

when they are still deep enough not to cough or gag on it

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15
Q

sizing OPA

A

corner of mouth to angle of jaw

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16
Q

sizing NPA

A

nare to angle of mandible

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17
Q

why are NPA commonly avoided in peds

A

to avoid trauma and bleeding with hypertrophic adenoids/swollen turbinates

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18
Q

how would you position an infant for intubation? what if they had hydrocephalus?

A

NAME?

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19
Q

how would you position an older child (12 years of age) for intubation

A

pillow under head (typically after 6 years of age)

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20
Q

ETT depth for 1 kg

A

7 cm

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21
Q

ETT depth for 2 kg

A

8 cm

22
Q

ETT depth for pt who is 3 kg

A

9 cm

23
Q

ETT depth for pt who is 4 kg

A

10 cm

24
Q

ETT depth for 1 year old

A

11 cm

25
Q

ETT depth for 2 year old

A

12 cm

26
Q

ETT depth for child > 2 years of age

A

12 + age/2

27
Q

T/F: awake tracheal intubations are common in peds

A

FALSE

28
Q

size of ETT in pt weighing less than 1 kg 1. cuffed ____________ 2. uncuffed ___________

A
  1. cuffed - N/A 2. uncuffed = 2 - 2.5 mm
29
Q

size of ETT in 1-2.5 kg pt 1. cuffed = __________ 2. uncuffed = ____________

A
  1. cuffed = N/A 2. uncuffed = 2.5 - 3.0
30
Q

size of ETT in neonate - 6 mo old 1. cuffed = ____________ 2. uncuffed = ____________

A
  1. cuffed = 3 2. uncuffed = 3 - 3.5
31
Q

size of ETT in 6 mo - 18 mo old 1. cuffed = _____________ 2. uncuffed = _______________

A
  1. cuffed = 3.5 2. uncuffed = 4
32
Q

size ETT in 18 mo - 2 year old 1. cuffed = ______________ 2. uncuffed = ____________

A
  1. cuffed = 4 2. uncuffed = 4.5
33
Q

formula for size of uncuffed ETT in children > 2 years of age

A

(age + 16)/4

34
Q

formula for size of cuffed ETT in children > 2 years of age

A

[(age + 16)/4] - 1/2 size

35
Q

what is the disadvantage of straight laryngoscope blades for peds

A

they can injure the epiglottis

36
Q

what was the theory behind using uncuffed ETT in children < 8 years of age

A

had decreased pressure on internal cricoid cartilage, thus caused less mucosal damage and decreased risk of post-extubation croup

37
Q

disadvantages to uncuffed ETT

A
  1. 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
38
Q

all cuffed ETTs in todays time are ____________ volume ___________ pressure

A

higher; lower

39
Q

what is a risk of prolonged intubation with cuffed ETT, esp in pre-term neonates

A

acquired subglottic stenosis

40
Q

what is the pathogenesis of acquired subglottic stenosis

A

there is ischemic injury to lateral wall pressure from ETT –> edema and narrowing of subglottic area

41
Q

advantages to cuffed ETT in peds

A
  1. less DL 2. better seal, which can be changed through the case if needed 3. decreased risk of aspiration
42
Q

typically you would go down __________ size from uncuffed for a cuffed ETT

A

2-Jan

43
Q

if you have placed a cuffed ETT, and are using N2O for the case, what should you be cautious of?

A

if long case, N2O can cause the cuff to expand –> so check cuff pressures

44
Q

advantage of LMA

A
  1. 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
45
Q

why should LMA still be cautioned in children with recent URI

A

because risk for laryngospasm is still so high

46
Q

what is the estimated blood volume in a preterm infant

A

100 mL/kg

47
Q

what is the estimated blood volume in a term infant

A

90 mL/kg

48
Q

what is the estimated blood volume in an infant

A

80 mL/kg

49
Q

what is the estimated blood volume in school aged child

A

70-75 mL/kg

50
Q

what is the estimated blood volume in an adult

A

70 mL/kg

Pediatrics (15 decks)

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