Peds facts Flashcards
what is the age for neonates
less than 30 days of age
what is the age for infants
1-12 months
what is the age for children
1-12 years
The CO of neonates is dependent on what? and why?
HR
bc SV is relatively fixed by a non-compliant and poorly developed left ventricle
CO is depedendent on what
HR
Neonate and infants compared to adult:
HR is what?
faster
Neonate and infants compared to adult:
BP is what?
lower
Neonate and infants compared to adult:
RR is what?
faster
Neonate and infants compared to adult:
lung compliance is what?
lower lung compliance
Neonate and infants compared to adult:
chest wall compliance
greater chest wall compliance
Neonate and infants compared to adult:
FRC
lower functional residual capacity
Neonate and infants compared to adult:
ratio of body surface to body weight
higher ratio of body surface to body weight
Neonate and infants compared to adult:
total body water content
higher total body water content
Neonate and infants compared to adult:
compliance of LV
non-compliant (less compliant than adult)
they have large what anatomically
head an tongues
Neonate and infants Anatomic differences:
what is unique about the nasal passage
narrow
Neonate and infants Anatomic differences:
what is unique about the larynx
narrow and cephalad
Neonate and infants Anatomic differences:
what is unique about their epiglottis
longer
Neonate and infants Anatomic differences:
what is unique about their trachea and neck
short
Neonate and infants Anatomic differences:
they usually have prominent what in the oral cavity
tonsils and adenoids
Neonate and infants Anatomic differences:
are their intercostal and diaphragm muscles weak or strong
weak
Neonate and infants Anatomic differences:
do they have high or low resistance to airflow
high resistance
Neonate and infants Pharmacologic differences:
what is unique about their hepatic biotransformation
it is immature
Neonate and infants Pharmacologic differences:
do they have increased or decreased protein binding?
decreased protein binding
Neonate and infants Pharmacologic differences:
do they have fast or slow induction and recovery?
rapid (fast)
Neonate and infants Pharmacologic differences:
do they have a large or small Vd for water soluble
large volume of distribution
Neonate and infants Pharmacologic differences:
what is unique about their NMJ
immature
where is the laryngeal location in the adult?
C3-C6
where is the laryngeal location in the per?
C2-C4
what is the narrowest part of the adult airway?
Glottis
what is the narrowest part of the ped airway
Cricoid (controversial lately)
what is the shape of the adult epiglottis?
V
what is the shape of the ped epiglottis?
Omega
what does the right main stem bronchus look like in the adult
more vertical
what does the right main stem bronchus look like in the pediatric
less vertical
Airways significance:
neonates are preferential what type of breathers
nasal
Airways significance:
the have narrow nares.. what does this mean
resistance is 12 times that of an adult
Airways significance:
what is a problem with their tongue
its large
Airways significance:
what is a problem with their glottis?
high glottis (more cephalad)
Airways significance:
what is the narrowest point of the airway in children younger than age 5
cricoid cartilage (controversal as of late)
ETT sizes ID:
Neonates
3-3.5 mm
ETT sizes ID:
infant 6 months to 1 year
3.5 - 4.0 mm
ETT sizes ID:
children 1-2 yrs
4.0-4.5 mm
ETT sizes ID:
what is the calcualtion for ETT size in peds
ETT = (16 + age) / 4
or (age / 4 ) + 4
ETT sizes:
how do you calculate the tube length at mouth
(cm / 10 ) + 5
or
( Kg / 5 ) + 12
Lung Volume
Va (mL /kg /min) of neonate? Child? adult?
Neo- 100-150
Child- 80
Adult - 60
Lung Volumes:
Frequency ( Min) of neonate? Child? adult?
Neo- 40
Child- 20
Adult- 10
Lung Volumes:
TLC ( mL/kg) of neonate? Child? adult?
Neo- 60
Child- 70
adult-80
Lung Volumes:
FRC ( mL/ kg) of neonate? Child? adult?
Neo- 30
Child- 32
Adult - 34
the decreased FRC in the infant means what with induction w/ inhalation agents
faster induction
Lung Volumes: Reserve volume (mL/kg) of neonate? Child? adult?
Neo- 20
child- 19
adult- 17
Lung Volumes:
Vt (mL/Kg) of neonate? Child? adult?
Neo- 6
Child - 7
Adult - 7
the increased closing capacity and decreased FRC make neonate prone to what?
atelectasis and hypoxia during anesthesia
why are neonates diaphragmatic breathers?
intercostals muscles underdeveloped
Diaphragm is high
chest cavity is small
State the HR; Systolic BP; and Diastolic BP:
Preterm
120-180
45-60
30
State the HR; Systolic BP; and Diastolic BP:
term
100-180
55-70
40
State the HR; Systolic BP; and Diastolic BP:
1 yr
100-140
70-100
60
State the HR; Systolic BP; and Diastolic BP:
3yr
85-115
75-110
70
State the HR; Systolic BP; and Diastolic BP:
5 yr
80-100
80-120
70
adult values
EBV:
premature
90 mL/kg
EBV:
infant
80 mL/kg
EBV:
toddler 6wk-2yrs
75 ml/kg
EBV:
child 2yrs - 12 yrs
72 mL/kg
EBV:
adult male
70 mL/kg
EBV:
Adult female
65 mL/kg
how much blood could a 4 kg, 4 month old loose if the hot is 36 and your lower level o f acceptance is hot of 29
75 mL/kg x 4 kg =300 mL 300 (36-29) / 36 = X 300 (7) / 36 = X 2100 / 36 = X 58.3 mL = X
how do you calculate fluid maintenance for a child
4:2:1 rule
4mL/kg for 1st 10 Kg
2mL/kg for 2nd 10 kg
1mL/kg for each kg over 20 kg
calculate the hourly fluid maintenance for a 27 kg child
4 x 10 = 40
2 x 10 = 20
1 x 7 = 7
= 67 mL/hr
State the fetal circulation
RA to RV to PA through PDA to aorta (bypass lungs) to infant
RA through FO to LA to LV to Aorta to infant
state the normal circulation post delivery
RA to RV to PA to Lungs to PV to LA to LV to Aorta to RA
what is the TBW%:
preterm
90%
what is the TBW%:
Term
80%
what is the TBW%:
6-12 mo
60%
why are infants of diabetic mothers prone to hypoglycemia?
the infant with produce insulin in response to maternal blood sugar to control it’s own blood glucose level. After delivery of the infant, the cord is clamped eliminating maternal blood flow. Now the infant will have their own stored insulin and this insulin will decrease the newborn;s blood sugar
why are infants prone to GERD and aspiration
incompetent LES
what is the most commonly used LA in infants and children i north america
Bupivacaine
what is the preferred concentration of LA for peripheral nerve block in the neonate
0.25% bupivacaine
What is the LA drug of choice for continuous infusion in the neonate?
Bupivacaine 0.1%
which LA can be used for most peripheral blocks and for caudal and epidural infusion in infants and children
Bupivacaine
what is the suggested maximum dose for bolus of injection int he caudal space or epidural space for older children and neonates? for infants?
4 mg/kg
2mg/kg