Peds final Flashcards
What size ETT for premie?
2-2.5 uncuffed
IM dose (&ml) of Succ for laryngospasm vs IV and IM for intubation
IM 0.25-0.5mg/kg for laryngospasm
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
What are the stages of anesthesia
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
Most common reason for bradycardia
Hypoxia?
What is tracheoesophageal fistula? most common type?
Esophagus is connected to the trachea
Type C or IIIB most common
What is a congenital diaphragmatic hernia? Signs and symptoms?
Abdominal contents enter the thoracic cavity usually on the left side
Respiratory distress, scaphoid abdomen, barrel chest, cardiac displacement
What is an omphalocele?
Abdominal defect (central) where gut is in a yolk sac
Bowel and liver
Less urgent
What is gastroschisis
Abdominal defect (lateral) with intestines exposed
Bowel only
More urgent- 300ml/kg/day IVF
NPO guidelines
2 clear liquids
4 breast milk
6 light meals
8 solids
What is the (functionally) narrowest portion of the pediatric airway?
Cricoid
What are the anomalies of down syndrome?
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
What are the implications of hypothermia?
Increased O2 consumption/ hypoxia
Increased glucose utilization/ hypoglycemia
Decreased surfactant/ reopening fetal circulation
Describe fetal circulation
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
What is tetralogy of fallot?
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)
What are the implications of a R-L shunt?
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)
What are the implications of a L-R shunt?
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)
What size ETT for term baby?
3
What size ETT for 6 month old?
3.5
What size ETT for 1 yr old?
4
What age child needs a 4.5 ETT?
18 months- 24 months
What is the formula for ETT sizing?
(Only for ages >2 years old)
(Age/4) +4- uncuffed
(Age/4)+3.5 cuffed
EBV in the premie, term, 6 month old
premie- 100ml/kg
term-85ml/kg
6 months- 80ml/kg
MAC of sevo
Sevo- 2 for adults, 2.5 children, 3.2 infants and neonates
Age of neonate
1-28 days
