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A1 > Peds final > Flashcards

Peds final Flashcards

1
Q

What size ETT for premie?

A

2-2.5 uncuffed

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2
Q

IM dose (&ml) of Succ for laryngospasm vs IV and IM for intubation

A

IV 0.4mg/kg for laryngospasm
IM 4mg/kg for intubation
IV 2mg/kg for intubation if >10kg
IV 1-2mg/kg for intubation if <10kg

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3
Q

What are the stages of anesthesia

A

1- Awake, eyes midline
2- hyper excitable, eyes divergent, delirium, excitation, vomiting, laryngeal spasm, htn, tachycardia, dilated pupils, tachypnea
3- eyes midline, surgical anesthesia, constricted pupils, regular respiration and depth, prevention of hotn and tachycardia, no movement
4- OD, dilated/nonreactive pupils, flaccid muscle tone, hotn, brady

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4
Q

Most common reason for bradycardia

A

Hypoxia?

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5
Q

What is tracheoesophageal fistula? most common type?

A

Esophagus is connected to the trachea
Type C or IIIB most common

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6
Q

What is a congenital diaphragmatic hernia? Signs and symptoms?

A

Abdominal contents enter the thoracic cavity usually on the left side
Respiratory distress, scaphoid abdomen, barrel chest, cardiac displacement

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7
Q

What is an omphalocele?

A

Abdominal defect (central) where gut is in a yolk sac
Bowel and liver
Less urgent

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8
Q

What is gastroschisis

A

Abdominal defect (lateral) with intestines exposed
Bowel only
More urgent- 300ml/kg/day IVF

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9
Q

NPO guidelines

A

2 clear liquids
4 breast milk
6 light meals
8 solids

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10
Q

What is the (functionally) narrowest portion of the pediatric airway?

A

Cricoid

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11
Q

What are the anomalies of down syndrome?

A

Cardiac- 50% have congenital heart disease (AVSD is most common, followed by VSD)
C spine abnormalities
microcephaly, small nasopharynx and mouth, high arch palate, AO instability, subglottic stenosis (use smaller ETT), large tongue make for difficult intubation and mask ventilation
HIGH risk of laryngospasm on extubation
Bradycardia is common on sevo induction- tx anticholinergics

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12
Q

What are the implications of hypothermia?

A

Increased O2 consumption/ hypoxia
Increased glucose utilization/ hypoglycemia
Decreased surfactant/ reopening fetal circulation

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13
Q

Describe fetal circulation

A

Start to finish
Mother- placenta- 1 umbilical vein (.8 spo2)- liver- ductus venosis bypasses liver- IVC (and SVC)- RA- IVC goes thru foramen ovale to LA (SVC goes to RV, then to PA, then mostly up to aorta via ductus arteriosis)- LV- aorta- body- 2 umbilical arteries (spo2 .58)- placenta

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14
Q

What is tetralogy of fallot?

A

1- RV outflow obstruction
2- RV hypertrophy (d/t above)
3- VSD (d/t rv outflow obstruction)
4- Overriding aorta receives blood from both ventricles (d/t VSD and strong RV)

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15
Q

What are the implications of a R-L shunt?

A

SLOWER inhalation induction- blood bypasses the lungs (mostly seen in insoluble agents)
FASTER IV induction-blood bypasses lungs and goes to the brain faster
Decreased pulmonary blood flow causes hypoxemia, lv overload
Tx- maintain SVR, decrease PVR (hyperoxia, hyperventilation, avoid lung hyperinflation)

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16
Q

What are the implications of a L-R shunt?

A

NO meaningful effect on induction speed
SLOWER IV induction (IV agent is recirculating in the lungs instead of going to the brain)
Decreased systemic blood- low CO, hotn
Increased pulmonary blood flow- pulmonary HTN, RVH
Tx- avoid increasing SVR, avoid decreased PVR (avoid alkalosis, hypocapnia, high fio2, vasodilators)

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17
Q

What size ETT for term baby?

A

3

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18
Q

What size ETT for 6 month old?

A

3.5

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19
Q

What size ETT for 1 yr old?

A

4

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20
Q

What age child needs a 4.5 ETT?

A

18 months- 24 months

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21
Q

What is the formula for ETT sizing?

A

(Only for ages >2 years old)
(Age/4) +4- uncuffed
(Age/4)+3.5 cuffed

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22
Q

EBV in the premie, term, 6 month old

A

premie- 100ml/kg
term-85ml/kg
6 months- 80ml/kg

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23
Q

MAC of sevo

A

Sevo- 2 for adults, 2.5 children, 3.2 infants and neonates

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24
Q

Age of neonate

A

1-28 days

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25
Q

Age of infant

A

1 month- 1 year

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26
Q

MAC of iso

A

Adults- 1.4
Children- 1.4
Infant- 1.8
Neonate- 1.6

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27
Q

MAC of des

A

Adults- 6.6
Children- 8.2
Infant- 10
Neonate- 9.2

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28
Q

What causes ductus arteriosis to constrict?

A

High pao2
High bradykinin
LOW PG E2

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29
Q

Roc dose

A

0.6mg/kg for standard induction
1.2mg/kg for RSI
(same as adults)

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30
Q

L-R shunt examples

A

VSD
ASD
PDA

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31
Q

R-L shunt examples

A

5 Ts- BLUE BABY
TOF
Transposition of the great arteries
Truncus arteriosis
Total anomalous pulmonary venous connection
Tricuspid valve abnormality (ebstein’s)

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32
Q

How do babys compensate for TOF?

A

Erythropoesis
However, this can lead to polycythemia and stroke/ embolism

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33
Q

What is a tet spell? How do children compensate?

A

1- SNS stimulation from crying, agitation, pain, trauma increases myocardial contractility
2- RVOT spasms, causing more shunting into LV
Compensate by squatting and hyperventilating

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34
Q

Anesthetic goals for TOF

A

Increase SVR (to send blood flow from RV to the lungs instead of LV)
Decrease PVR
Maintain normal hr/ inotropy- esmolol
Increase preload- crystalloid, albumin
Ketamine 1-2mg/kg IV or 3-4mg/kg IM for induction
Avoid morphine, meperdine, atracurium (histamines causing reduced SVR)
“Boot” shaped heart on cxr, R deviation

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35
Q

TEF associated symptoms?

A

Choking, coughing, cyanosis during oral feeding

36
Q

Anesthetic management for TEF

A

Head up/ frequent suction
Awake intubation/ inhalation induction with spontaneous ventilation
G tube for gastric decompression, open current g tube to atmosphere

37
Q

Pre term definition

A

<37 weeks

38
Q

What age can a fetus survive with artificial ventilation

A

24 weeks- alveoli and surfactant are detectable

39
Q

What is the primary event of the respiratory system?

A

Initiation of ventilation

40
Q

What can help the neonate maintain FRC/lung inflation during anesthesia?

A

5cm h2o PEEP

41
Q

___ is abolished by hypothermia and low levels of anesthetic gases

A

Hyperneic response to hypoxia

42
Q

Ductus arteriosis; physiologic closure in ___, anatomic closure in ___

A

10 hours
2 week

43
Q

Lowest acceptable HCT

A

35%

44
Q

Pedis have ___ cardiac output when compared to adults

A

Increased

45
Q

Pedis have ___ EBV when compared to adults

A

Increased

46
Q

What is the major component of thermal regulation in the neonate?

A

non shivering thermogenesis- metabolism of brown fat, develops by 30weeks, located in the mediastinum, scapulae, adrenals, axilla
Occurs with COLD and STRESS

47
Q

Cold stress consequences

A

Increased o2 consumption
Increased glucose utilization
Decreased surfactant

48
Q

__ age is most important when determining maturity of drug metabolism

A

Post natal age (NOT gestational)

49
Q

Prop dose

A

2-3mg/kg

50
Q

Benzo dose

A

0.1 mg/kg

51
Q

Ketamine dose

A

2mg/kg iv
5mg/kg im

52
Q

morphine, fent, remifent dose

A

morphine 0.1mg/kg
fent 1-5mcg/kg
remifent 0.02-2mcg/kg/min

53
Q

atropine ad glyco dose

A

10-20mcg/kg

54
Q

Sugammadex dose

A

2mg/kg for shallow (t2 appearance)
4mg/kg for deep (post tetanic)
16mg/kg for rescue dose after intubating dose

55
Q

Children are ___ more resistant to LA toxicity

A

not

56
Q

First sign of la toxicity

A

CV collapse, dysrhyhtmias

57
Q

MAX local doses- lido, bupiv, ropiv

A

Lido 5mg/kg (7 w epi, 3mcg/kg/dose max with re injection after 30 min)
Bupiv 2.5mg/kg
Ropiv 1ml/kg

58
Q

Precedex dose

A

1mcg/kg bolus
0.2-1mcg/kg/hr

59
Q

Greatest concern for congenital hip dislocation

A

loss of airway

60
Q

Clinical presentation of CDH

A

dyspnea
cyanosis
dextrocardia

61
Q

pyloric stenosis presentation

A

hyponatremic, kalemic, chloremic, met alkalosis

62
Q

__ is the primary concern for pyloric stenosis

A

aspiration

63
Q

Pediatric airway is __ shaped

A

funnel

64
Q

Pediatric airway is at the level of

A

C3
C4

65
Q

What will increase pvr

A

hypoxia???
Hypoxemia
hypercapnia
acidosis
hypothermia

66
Q

Max PIP for CDH

A

25cm h2o

67
Q

Where to monitor pre ductal spo2 in CDH

A

R arm, should be above 90%

68
Q

When is CDH normally repaired?

A

10 days

69
Q

Abdominal closure may ____ abdominal pressure which will cause ___

A

increase
Cause decreased venous return, decreased co and perfusion

70
Q

Monitor spo2 on the ___ to monitor for impaired venous return

A

l lower extremity

71
Q

LATE finding in untreated pyloric stenosis

A

met acidosis from lactic acidosis from severe dehydration
first will be met alkalosis, hyponatremia, hypokalemia, hypochloremia

72
Q

When does pyloric stenosis occur

A

2-12 weeks old

73
Q

plyoric stenosis is more common in ___

A

males- more hypertrophy

74
Q

Dehydration from pylroic stenosis should be corrected with ____, then maintenance should be ____

A

20ml/kg before surgery
d5/.5NS 1.5x maintenance rate

75
Q

Until 44 weeks PCA, spo2 should be maintained ____

A

89-94% from preductal bc it better correlates with retinal vessels

76
Q

Which congenital conditional most needs awake intubation?

A

TEF, prevent gastric distention

77
Q

Who needs RSI?

A

pyloric stenosis
prevent aspiration

78
Q

pyloric stenosis associations

A

not typically

79
Q

nueraxial ropivicaine dose

A

1ml/kg of 0.2% ropiv

80
Q

volume per location

A

thoracic 1.5ml/kg
lumbar 1ml/kg
sacral 0.5ml/kg

81
Q

guideline for depth for epidurals

A

1mm/kg

82
Q

max dose- bup, lido, lido w epi, ropiv

A

bup 3mg/kg
lido 5mg/kg
epi 7mg/kg
ropiv 3mg/kg

83
Q

cx to neuraxial block

A

coags
infection severe/ meningitis, septicemia
hydrocephalus/ intracranial process
true allergy
hemodynamic instable
demyelinating disease
chemo

84
Q

max volume and dose for caudal

A

volum 25ml
dose 3mg/kg

85
Q

___ of LA with ____ epi for test dose, MAX is __

A

0.1ml/kg
5mcg/ml
MAX 3ml

86
Q

max dose tylenol oral

A

15mg/kg

87
Q

post intubation laryngeal edema

A

0.5ml 2.25% solution in 3ml saline
epi

A1 (124 decks)

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