peds deck 6 Flashcards
why are electrolyte disturbances common in children?
- large SA:volume 2. immature homeostatic mechanism
TBW _______________ with development
decreases
as neonate develops and ages, most of the losses of TBW are ________________ losses
extracellular
kidney vascular resistance _____________ after birth, which causes abrupt increase in ___________ & _________
decreases; GFR and RBF
urine concentrating ability in neonates is about ____________ of that of an adult
50%
RPF and GFR = ____________% of that of an adult at 6 months of age and ____________% that of an adult at 1 year
50; 90
basic fluid management in peds
- 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
minimal third space losses you would replace ____________ mL/kg/hr
4-Mar
moderate tissue trauma you would replace ____________ml/kg/hr for third space losses
10-May
for severe surgical tissue trauma (open belly) you would replace ________ mL/kg/hr and possibly up to ________ ml/kg/hr for necrotizing enterocolitits
10-15; 50
what is the standard NPO mainteance fluid for healthy child
D51/2 NS
what type of fluid should you use for OR mainteance
isotonic
under what circumstances may you consider a dextrose IV solution
- malnourished children 2. neonates and infants < 6 mo 3. cardiac surgery
neonates lose _________% of body weight after birth but will gain it back if adequately fed within the first couple of weeks
15-May
glucose levels in the neonate are ________% of that of maternal values
60-70 (risk for hypoglycemia)
most glucose stores are depleted within the first __________ hours in an unstressed baby
48
what types of pediatric situations is there even more careful fluid balance needed in the neonate
- necrotizing enterocolitis 2. cardiac dz 3. lung dz
why can IV access be so difficult in pediatrics
- long NPO time 2. obesity 3. ex-premature or sick patient 4. if awake 5. high anxiety
what are some ways to make placing an IV in an awake pediatric pt less difficult?
- premedication 2. distraction 3. warm towels/compresses 4. numbing medication 5. possibly parental presence
what are the most common places to place an IV in peds
- saphenous vein (preferred for larger cath) 2. hand veins 3. AC (preferred for larger cath) 4. wrist 5. feet 6. scalp 7. neck
inserting an IO in peds
- 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
albumin considerations in pediatrics
- 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
if a child loses 10% of blood volume, what should you replace it with?
crystalloid (3:1 - LR preferred)
if child loses 10-20% of blood volume, what should you replace it with?
crystalloid (3:1) or colloid (1:1)
if child loses > 20% of blood volume, what should you replace it with
blood products (1:1)
under what circumstances would you use FFP in peds
- massive transfusion 2. coagulation issues
under what circumstances would you use plts in peds
- massive transfusion 2. low plts
under what circumstances would you use PRBC in peds
- low H/H (drop of hgb < 7) 2. high blood loss surgery 3. postop
10 mL/kg of PRBC will raise hct by ___% and hgb by _____
10; 3
calculating amount of blood replacement
(maximum allowable blood loss x desired hct) / hct of PRBC
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)
neuronal; glial; synaptogenesis
____________________ is programmed cell death in the brain
neuroapoptosis
what 2 receptors have been identified with “developmental” neuroapoptosis
- NMDA 2. GABA
neocortex has 6 layers. Layer ________ is the main target of information from the thalamus where glutamate and gaba are found
4
what areas of the brain are affected by neuroapoptosis
- neocortex 2. hippocampus 3. hypothalamus 4. amygdala
which area of the brain is responsible for spatial learning and memory and can be impacted by neuroapoptosis
hippocampus
what area of the brain is responsible for behavior, body homeostasis, and food intake and can be impacted by neuroapoptosis
hypothalamus
what area of the brain is responsible for memory, fear, and emotions, and can be impacted by neuroapoptosis
amygdala
IV dose of ketamine (induction)
1-3 mg/kg
CV s/e of ketamine
- typically increase: BP, HR, CO, and myocardial O2 demand (due to indirect inhibition of catechol reuptake) 2. in catecholamine depleted pt these can decrease
pulmonary s/e ketamine
- bronchodilation 2. increased secretions
neuro s/e of ketamine
- increases CBF and CMRO2 2. vasodilator 3. increases ICP 4. emergence delirium
metabolism of ketamine
CYP450
why do we like ketamine in peds
its almost a complete anesthetic: 1. amnesia 2. anaglesia 3. dissociation 4. favorable cardiac profile
what pediatric populations would you give ketamine to?
- 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
CV s/e of midazolam
- slight decrease in BP 2. CO unchanged
pulmonary s/e midazolam
dose dependent depression
Neuro s/e of midazolam
- decrease CMRO2 and CBF 2. anxiolysis 3. amnesia 4. anticonvulsant 5. sedation
dose of IV midazolam
0.1 - 0.15 mg/kg
dose of midazolam PO or IN
0.3-0.5 mg/kg
