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Pediatrics > peds deck 6 > Flashcards

peds deck 6 Flashcards

1
Q

why are electrolyte disturbances common in children?

A
  1. large SA:volume 2. immature homeostatic mechanism
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2
Q

TBW _______________ with development

A

decreases

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3
Q

as neonate develops and ages, most of the losses of TBW are ________________ losses

A

extracellular

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4
Q

kidney vascular resistance _____________ after birth, which causes abrupt increase in ___________ & _________

A

decreases; GFR and RBF

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5
Q

urine concentrating ability in neonates is about ____________ of that of an adult

A

50%

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6
Q

RPF and GFR = ____________% of that of an adult at 6 months of age and ____________% that of an adult at 1 year

A

50; 90

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7
Q

basic fluid management in peds

A
  1. 4-2-1 for maintenance rate 2. calculate NPO deficit (maint x hours NPO - mL of clears) 3. replace 1/2 of deficit over 1st hour and 2nd half over next 2 hours 4. third space losses (mild = 3-4; mod = 5-10; severe = 10-15) 5. evap losses (do not include in the first hour) 6. general rule: no greater than 20 mL/kg/hr
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8
Q

minimal third space losses you would replace ____________ mL/kg/hr

A

4-Mar

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9
Q

moderate tissue trauma you would replace ____________ml/kg/hr for third space losses

A

10-May

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10
Q

for severe surgical tissue trauma (open belly) you would replace ________ mL/kg/hr and possibly up to ________ ml/kg/hr for necrotizing enterocolitits

A

10-15; 50

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11
Q

what is the standard NPO mainteance fluid for healthy child

A

D51/2 NS

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12
Q

what type of fluid should you use for OR mainteance

A

isotonic

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13
Q

under what circumstances may you consider a dextrose IV solution

A
  1. malnourished children 2. neonates and infants < 6 mo 3. cardiac surgery
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14
Q

neonates lose _________% of body weight after birth but will gain it back if adequately fed within the first couple of weeks

A

15-May

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15
Q

glucose levels in the neonate are ________% of that of maternal values

A

60-70 (risk for hypoglycemia)

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16
Q

most glucose stores are depleted within the first __________ hours in an unstressed baby

A

48

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17
Q

what types of pediatric situations is there even more careful fluid balance needed in the neonate

A
  1. necrotizing enterocolitis 2. cardiac dz 3. lung dz
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18
Q

why can IV access be so difficult in pediatrics

A
  1. long NPO time 2. obesity 3. ex-premature or sick patient 4. if awake 5. high anxiety
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19
Q

what are some ways to make placing an IV in an awake pediatric pt less difficult?

A
  1. premedication 2. distraction 3. warm towels/compresses 4. numbing medication 5. possibly parental presence
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20
Q

what are the most common places to place an IV in peds

A
  1. saphenous vein (preferred for larger cath) 2. hand veins 3. AC (preferred for larger cath) 4. wrist 5. feet 6. scalp 7. neck
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21
Q

inserting an IO in peds

A
  1. locate tibial tuberosity 2. go 2cm below - flat spot 3. local if pt is awake 4. advance through SubQ until bone felt 5. twist into bone with firm pressure until feel loss of resistance 6. aspirate marrow for confirmation
22
Q

albumin considerations in pediatrics

A
  1. considered a blood product - consider jehovahs witness 2. 5% - only concentration used 3. supports intravascular volume 4. more effective with slow infusion instead of bolus 5. not used a lot in peds
23
Q

if a child loses 10% of blood volume, what should you replace it with?

A

crystalloid (3:1 - LR preferred)

24
Q

if child loses 10-20% of blood volume, what should you replace it with?

A

crystalloid (3:1) or colloid (1:1)

25
Q

if child loses > 20% of blood volume, what should you replace it with

A

blood products (1:1)

26
Q

under what circumstances would you use FFP in peds

A
  1. massive transfusion 2. coagulation issues
27
Q

under what circumstances would you use plts in peds

A
  1. massive transfusion 2. low plts
28
Q

under what circumstances would you use PRBC in peds

A
  1. low H/H (drop of hgb < 7) 2. high blood loss surgery 3. postop
29
Q

10 mL/kg of PRBC will raise hct by ___% and hgb by _____

A

10; 3

30
Q

calculating amount of blood replacement

A

(maximum allowable blood loss x desired hct) / hct of PRBC

31
Q

there two major “growth spurts” in braind development, the first occurs between 15 - 20 weeks gestation, where _____________ proliferate, the second is multiplication of __________ cells (i.e. _____________ period)

A

neuronal; glial; synaptogenesis

32
Q

____________________ is programmed cell death in the brain

A

neuroapoptosis

33
Q

what 2 receptors have been identified with “developmental” neuroapoptosis

A
  1. NMDA 2. GABA
34
Q

neocortex has 6 layers. Layer ________ is the main target of information from the thalamus where glutamate and gaba are found

A

4

35
Q

what areas of the brain are affected by neuroapoptosis

A
  1. neocortex 2. hippocampus 3. hypothalamus 4. amygdala
36
Q

which area of the brain is responsible for spatial learning and memory and can be impacted by neuroapoptosis

A

hippocampus

37
Q

what area of the brain is responsible for behavior, body homeostasis, and food intake and can be impacted by neuroapoptosis

A

hypothalamus

38
Q

what area of the brain is responsible for memory, fear, and emotions, and can be impacted by neuroapoptosis

A

amygdala

39
Q

IV dose of ketamine (induction)

A

1-3 mg/kg

40
Q

CV s/e of ketamine

A
  1. typically increase: BP, HR, CO, and myocardial O2 demand (due to indirect inhibition of catechol reuptake) 2. in catecholamine depleted pt these can decrease
41
Q

pulmonary s/e ketamine

A
  1. bronchodilation 2. increased secretions
42
Q

neuro s/e of ketamine

A
  1. increases CBF and CMRO2 2. vasodilator 3. increases ICP 4. emergence delirium
43
Q

metabolism of ketamine

A

CYP450

44
Q

why do we like ketamine in peds

A

its almost a complete anesthetic: 1. amnesia 2. anaglesia 3. dissociation 4. favorable cardiac profile

45
Q

what pediatric populations would you give ketamine to?

A
  1. cardiac pts - esp if unrepaired (tetralogy any dz where dont want sVR to drop) 2. uncooperative 3. emergence reaction 4. neonates 5. burn pts 6. pts with mitochondrial d/o
46
Q

CV s/e of midazolam

A
  1. slight decrease in BP 2. CO unchanged
47
Q

pulmonary s/e midazolam

A

dose dependent depression

48
Q

Neuro s/e of midazolam

A
  1. decrease CMRO2 and CBF 2. anxiolysis 3. amnesia 4. anticonvulsant 5. sedation
49
Q

dose of IV midazolam

A

0.1 - 0.15 mg/kg

50
Q

dose of midazolam PO or IN

A

0.3-0.5 mg/kg

Pediatrics (15 decks)

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