Peds Quizlet Flashcards
1
Q
Anatomical changes: head
A
larger occiput
2
Q
Anatomical changes: respiration pattern
A
obligate nose breathers
3
Q
Anatomical changes: Larynx. What vertebrae is it located at?
A
more cephalad - C3-C4
4
Q
Anatomical changes: epiglottis
A
omega shaped and longer
5
Q
Anatomical changes: vocal cords
A
slant caudally at arytenoid insertion
6
Q
Anatomical changes: trachea
A
shorter, 4-5 cm
7
Q
What is the (functionally) narrowest part of the pediatric airway?
A
Cricoid ring
8
Q
Anatomical changes: right mainstem bronchus
A
acute angle at the carina
9
Q
Pediatric patients have turbulent gas flow until the ______th (#) bronchial division
A
5
10
Q
Resistance is inversely related to _________ to the _______ power
A
radius; 5th
11
Q
A 50% reduction in the radius of the cricoid ring ___________(increases/decreases) pressure drop by ______ times, which increases work of breathing
A
decreases, 32
12
Q
What is the ratio of alveolar ventilation: FRC in children compared to adults? Why?
A
5:1 vs. 1.5:1; because of their increased O2 consumption per kg
13
Q
Anatomical changes: rib cage
A
increased compliance
14
Q
anatomical changes: lung compliance. Why?
A
decreased - lack of elastin
15
Q
anatomical changes: fibers in the diaphragm - what is the significance of this?
A
There are reduced type 1 fibers which are the “marathon runner fibers” - aka the longer acting fibers. Makes patient more likely to have fatigued muscles leading to respiratory failure
16
Q
What is the most common problem leading to upper airway obstruction in pediatrics and how is it treated?
A
Laryngomalacia; positive pressure, usually resolves with age
17
Q
Name that condition: Supraglottic structures converge on the glottic opening, leading to retractions, paradoxical chest movement, and exaggerated diaphragm excursion
A
Laryngomalacia
18
Q
Name that condition: Micrognathia, airway distress, glossoptosis
A
Pierre Robin
19
Q
Name that condition: airway becomes MORE difficult with age
A
Treacher collins
20
Q
True or false: down syndrome patients, and those with Crouson and Apert disease are often difficult intubations?
A
False - they are difficult to mask but easy intubation
21
Q
What is the airway finding associated with both down syndrome and beckwith syndrome?
A
large tongue
22
Q
What is the airway finding associated with “please get that chin” (pierre robin, goldenhar, treacher collings, cri du chat)
A
Small mandible
23
Q
What is the airway finding associated with the acronym “kids try gold” (Klippel-feli, trisomy 21, goldenhar)
A
cervical spine anomaly
24
Q
True or false: trisomy 21 patients often have large tongues and cervical spine anomalies
A
T
25
True or false: goldenhar patients often have small jaws and cervical spine anomalies
T
26
Name that condition: small smouth, small mandible, choanal atresia, eye and ear anomalies
Treacher Collins
27
Name that condition: small mouth, large tongue, atlantoaxial instability, small subglottic diameter
Trisomy 21
28
Name that condition: small mandible/ micrognathia, tonge that falls back and downwards (glossoptosis)
pierre robin
29
Name that condition: small mandible, laryngomalacia, stridor
Cri du chat
30
Increase/ Decrease in Peds: atelectasis risk
increase
31
Increase/ Decrease in Peds: O2 reserve and FRC
decrease
32
Increase/ Decrease in Peds: PNS activity
relative increase
33
Increase/ Decrease in Peds: SV compensation/ SVR tone
decrease
34
Increase/ Decrease in Peds: CBF? What is normal?
increase - normal is 70-110ml/100g of brain/min
35
Increase/ Decrease in Peds: CMRO2? What is normal?
increase - 5.5ml/100g/min
36
Increase/ Decrease in Peds: Autoregulation
no change
37
Increase/ Decrease in Peds: pH of gastric juice
increase (less acidic)
38
Increase/ Decrease in Peds: Albumin and Alpha-1 Glycoprotein. Which one binds to basic drugs?
decrease - Alpha 1 binds to basic
39
Increase/ Decrease in Peds: GFR
decrease
40
Why is CO so heart rate dependent in pediatric patients?
There is reduced ability to compensate by increases stroke volume
41
Atropine increases CO in peds patients in 2 ways, what are they?
1. increasing HR
2. augmenting calcium force
42
Normal HR and BP: 0-3 months
HP: 100-150
BP: 60-85/ 45-55
43
Normal HR and BP: 3-6 months
HR: 90-120
BP: 70-90/ 50-65
44
Normal HR and BP: 6-12 months
HR: 80-120
BP: 80-100/ 55-65
45
Normal HR and BP: 1-3 years
HR: 70-110
BP: 90-105/ 55-70
46
Normal HR and BP: 3-6 years
HR: 65-110
BP: 95-110/60-75
47
Normal HR and BP: 6-12 years
HR: 60-95
BP: 100-120/60-75
48
Normal HR and BP: >12 years
HR: 55-85
BP: 110-135/ 65-85
49
Increase or decrease in peds: O2 consumption - what is normal?
increase - 5.5ml/100g/min
50
CBF in children is directed largely towards ________ matter
gray
51
Drugs that act on NMDA/GABA receptors cause _______ in children. What can help reduce these effects?
Apoptosis (programmed cell death)
Helps: melatonin, lithium, hypothermia, exercise
52
True or false: rectal drugs can undergo first-pass metabolism
True- if they are absorbed via rectal superior veins which drain into the portal venous system
53
The free fraction of lidocaine will be greater in __________ (younger/older) children. Why?
Younger - decreased Alpha 1 Glycoprotein which binds to basic drugs - increases with age
54
Phase 1 or Phase 2:
-Hydroxylation
-Oxidation
-Glucoronidation
Hydrox.: 1
Ox: 1
Gluco: 2
55
True or false: The liver does not metabolize drugs well at birth because it is lacking the CYP enzymes needed to do so?
False - enzymes are present but not mature enough (they have not been induced)
56
Which enzyme metabolizes 50% of drugs?
CYP450 3A4
57
4 reasons why inhalation induction is faster in pediatric patients?
1. increased alveolar ventilation: FRC ratio
2. Greater distribution of CO to vessel rich group
3. Reduced tissue solubility
4. Reduced blood solubility
58
Does this effect the wash-IN (lung delivery) or wash-OUT (anesthetic removal) of inhaled agents: Inspired concentation
wash-in
59
Does this effect the wash-IN (lung delivery) or wash-OUT (anesthetic removal) of inhaled agents: alveolar ventilation to FRC ratio
wash-in
60
Does this effect the wash-IN (lung delivery) or wash-OUT (anesthetic removal) of inhaled agents: Blood gas solubility
wash out
61
Does this effect the wash-IN (lung delivery) or wash-OUT (anesthetic removal) of inhaled agents: cardiac output
wash out
62
Does this effect the wash-IN (lung delivery) or wash-OUT (anesthetic removal) of inhaled agents: alveolar-venous partial pressure gradient
wash out
63
What is the inhaled agent of choice in pediatrics and why?
sevoflurane - less airway irritation
64
Changes in alveolar ventilation and cardiac output affect the wash-in of __________(less/more) soluble anesthetics to a greater extent?
more
(Nagelhout highway example - the slow cars are going to feel the speed-up more than the fast cars)
65
Wash-in of ______ solubility anesthetics (high/low) are similar between peds and adults?
low
66
Order these from least soluble to most soluble: Sevo, Iso, Halothane, Des
1. Des
2. Sevo
3. Iso
4. halothane
67
Spontaneous ventilation works to speed up inhaled induction via _______ feedback (negative/positive), whereas controlled ventilation works to speed up inhaled induction via __________ feedback (negative/positive).
Negative; positive
68
Explain the "negative feedback" of inhaled induction with spontaneous ventilation
Inhaled anesthetic washes in, and depth of anesthesia increases
As patient gets deeper, breathing is reduced, and therefore uptake of agent is reduced
As agent is redistributed from brain and depth of anesthesia decreases, then ventilation increases again, and uptake is resumed
69
Explain the "positive feedback" of inhaled induction with controlled ventilation?
Delivery of inhaled agent to the lungs continues which deepens anesthesia
Deeper anesthesia decreases cardiac output
Decreased cardiac output further increases speed of IA induction
70
A cardiac shunt in which direction greatly impacts wash-in of low solubility inhalation agents? how?
Right to left
Because blood is bypassing the lungs, therefore not interacting with the inhaled agent in the alveoli
71
At what age does MAC peak?
1-6 months
72
Is the effect of N2O on the patient's MAC (when on sevo and des) increased or decreased in pediatric patients as compared to adults?
decreased - 60% O2 only contributes 25% to the MAC value
73
One degree drop in a child's temperature will decrease his/her MAC by _______%
5
74
What does sevoflurane do to cardiac index?
Decreases is by 10% at 1 MAC, 20-30% at 2 MAC
75
What does IA's do to tidal volume and respiratory rate? What about minute ventilation?
Decreased tidal volume
Increase RR
Decrease MV
76
What do IAs do to the response to CO2 and hypoxia?
Decrease it
77
Airway resistance __________(increases/decreases) with Des, and ___________ (increases/decreases) with Sevo.
Increases; decreaeses
78
What do do IAs do to QT interval?
Prolong it (>500 msec)
79
Patients with low values of what 4 labs are at increased risk for torsades?
1. mag
2. potassium
3. calcium
4. thyroid hormone (T3/T4)
80
True or false: Tachycardia puts the patient at increased risk for torsades with prolonged QT from IAs?
False; bradycardia
81
True or false: Male gender puts the patient at increased risk for torsades with prolonged QT from IAs?
False; female
82
Which IA uncouples CBF/CMRO2 the LEAST in children?
Sevo (followed by Iso, then Des)
83
BIS is not precise under the age of ______
5yr
84
True or false: Sevoflurane at 1 MAC impairs autoregulation in children
false - only > 1.5 MAC
85
How can the anesthetist help repair autoregulation that has been impaired by high concentrations of Iso or Sevo
hyperventilation
86
Vd and clearance of propofol _________(increase/decrease) during early childhood
decrease
87
True or false: propofol should be avoided in children with an egg allergy (per Barash)
True- kinda- only in egg ANAPHYLAXIS
88
What is an effective blood concentration of Ketamine for anesthesia?
3 mcg/mL
89
IV, IM, and PO doses of ketamine
IV: 1-2 mg/kg
IM: 2-5 mg/kg
PO: 5-6 mg/kg
90
How long does it take IM ketamine to onset? When does it peak?
Onset 3-5 min, peak 30-40
91
Appropriate dose of Etomidate in children?
0.3 mg/kg
92
What is the neonatal infant dose of succinycholine and why? What about children?
Neonate: 3-4 mg/kg due to larger Vd
Children: 2 mg/kg
93
What is the most common pediatric side effect of succinylcholine? Why? How can you prevent it?
bradycardia - ACh activation of vagal nerves
Pre-treat with 10/20 mcg/kg of atropine or 5-10 mcg/kg of glyco
94
How can you treat Hyperkalemia caused by succinylcholine and how does this work?
10mg/kg CaCl - raises threshold potential to prevent arrhythmias
95
How much does IOP increase with succinylcholine and when does it peak?
7-10 mm Hg, peaks in 1-2 min
96
What kind of children are at risk for muscle pain after succ and how can you prevent this?
Muscular adolescents - pre-treat with NDMB
97
What is the earliest sign of MH
increase in ETCO2 accompanied by and increase in RR and low SpO2
98
Dantrolene dose
2.5 mg/kg
repeated q5-10 min
99
True or false: Roc is exclusively eliminated by the liver
T
100
Potency of rocuronium is greatest in what age group and the least in what age group?
Greatest in infants, least in children?
101
What commonly used anesthetic agent potentiates the effect of rocuronium?
sevo
102
Rocuronium dose in infants vs. children
Infants: 0.25mg/kg
Children: 0.4-0.6 mg/kg
103
Increase or decrease in peds: dose of Neostigmine
decrease - dose is 30-40% of adult dose
20-40 mcg/kg up to 70 mcg/kg
104
Neostigmine dose of > _______ mcg/kg may cause ACh associated weakness
100
105
Fentanyl is ______ soluble (lipid/water), and primarily bound to ________(albumin/ AAG)
lipid, AAG
106
What is an IV dose of fentanyl appropriate for pediatric patients?
Minor: 1-3 mcg/kg
Major: 12-50 mcg/kg
107
What is an appropriate pediatric dose of Meperidine for shivering?
0.5-1 mg/kg
108
Black box warning for codeine is for what?
Respiratory depression
109
Ibuprofen vs. Acetaminophen dosing
Acetaminophen: 10-15 mg/kg PO; 20-40 mg/kg PR
Ibuprofen: 10-15mg/kg PO
110
Midazolam is ______ soluble (water/lipid)
water
111
IV vs. Nasal versed dosing
IV: 0.1-0.2 mg/kg
Nasal: 0.2-0.3 mg/kg
112
True or false: Precedex has hemodynamic manifestations via direct AND indirect action on the SNS
T
113
What is the appropriate IV loading dose and infusion rate of precedex?
Load: 1 mcg/kg over 10 minutes
Drip: 0.3-0.7 mcg/kg/HOUR (not minute)
114
What effect does precedex have on the MAC of IAs?
decreases it by 30%
115
True or false: bradycardia from precedex should be immediately treated with glyco
false - this may lead to HTN
116
Perioperative cardiac arrest in pediatrics is a higher risk in what 3 types of patients?
<1 year, CHD, or emergent surgical patients
117
What should you tell your patient's parents if they ask whether or not general anesthesia can cause brain dysfunction?
There is insufficient evidence to prove this, but there are some reports that anesthesia causes apoptosis (cell death) .....I'm sure this will go well.
118
True or false: there is a cross-sensitivity between and PCN allergy and Cefazolin?
True - cefazolin is a first-generation cephalosporin
119
If a child's PCN allergy is >5 years ago, what can you offer to do for the parent?
Test-dose them while monitoring
120
Children who have ingested solid food within _______ hours of trauma are at risk for aspiration?
8
121
True or false: If a child presents with gum, the surgery must be cancelled
False - they have to spit it out
122
What happens to gastric volume and pH after chewing gum?
Volume is doubled, no change in pH
123
Tures or false: Obesity in children increases the risk of pneumonitis with aspiration?
False - obesity, like gum, increases gastric volume but gastric pH is unchanged
124
True or false: children with type 1 DM are considered to have gastroparesis
false - takes years to develop
125
NPO guidelines:
-clear liquids
-Breast milk
-infant formula/cow's milk
-solid food
Clear: 2 hours
BM: 4 hours
Formula/Dairy milk: 6 hours
Solid: 8 hours
126
Hgb should be drawn pre-op on children of what age?
< 6 months, or < 1 year if premature
127
Pregnancy tests are often done in female children age ______ and older
10
128
What pulmonary sound would alert the anesthetist that the child should receive a CXR and pulm. consult?
Rales/rhonchi that do NOT clear with coughing
129
Name 5 pre-op respiratory assessment points that are unique to kids
URI
Smoke exposure
Hx of BPD, tracheo or larnygomalacia
Nasal flaring
color of mucous membranes
130
What drug displaces billirubin and puts patients at increased risk for surgical bleeding?
Indomethacin
131
What drug puts patients at risk for seizures, HoTN, cerebral irritability, and pyrexia?
Prostaglandins
132
What drug may cause rebound PPHN with withdrawal?
Prostacyclin
133
What is the leading cause of case cancellation in children?
URI
134
Children who've had a recent UTRI should not undergo elective anesthesia for ____________ weeks after the infection. Airway irritability can persist for up to _____ weeks.
4;6
135
If children come in with a clear runny nose, what can you do?
Dilute neosynephrine to 0.25% and drop in nose to dry secretions
136
True or false: for a patient with high risk of airway reaction, and ETT is the less triggering device
false- LMA is less likely to trigger a response than an ETT
137
4 criteria for case cancellation with URTI:
1. fever > 38.5
2. altered behavior
3. purulent, productive upper airway discharge
4. lower tract signs (wheezing, rhonchi) that do not clear with coughing
138
If a patient presents with a recent UTRI and one of these 3 things, they are at a high risk of perioperative airway events and the case should be cancelled?
1. Asthma
2. < 1 year old
3. sickle cell disesase
139
Mechanical irritation with an ETT increases the risk of bronchospasm by _______-fold
10
140
Dexamethasone dose of ___________mg/kg will reduce the risk of croup
0.25-0.5
141
True or false: pre-treatment with a bronchodilator reduces the risk of airway issues
F
142
What medication and dose may be administered intra-operatively to reduce post-operative apnea? What puts patients at high risk for post-operative apnea?
Caffeine 10mg/kg IV
Former prematurity, < 60 weeks post-conception, Hgb <12%, secondary diagnosis
143
What type of temperature monitoring is preferred in pediatric MH and why?
Axillary - reflects the temp in the largest muscle bulk in the chest
144
True or false: daytime somnolence is required to diagnose OSA in children
False- it is not a common symptom
145
Children with OSA who have a minimum nocturnal SpO2 of _______% are at risk for ________________ sensititivy
85; opioid
146
3 triggering factors of a sickle cell crisis
hypoxia, hypovolemia, hypothermia
147
Obesity in children is considered to be > _______ percentile
95th
148
Parental presence during induction should not be used for children under ______ months old
8
149
Younger children would require a _________(higher/lower) dose of PO versed as compared to older children. Why?
Higher; poor bioavailability
150
What gauge needle should be attached to your emergency atropine and succinylcholine?
23 or 25g
151
Recommended blade: Neonate
Miller 0
152
Recommended blade: 1-2 years
Miller/Mac 1; WH 1
153
Recommended blade: 3-4 years
WH 1.5
154
Recommended blade: > 4 years
Miller 2
155
Recommended blade: 3-5 years
Mac 2
156
Uncuffed tube Diameter: <1500 g neonate
2.5mm
157
Uncuffed tube Diameter: 1500 g- full term neonate
3mm
158
Uncuffed tube Diameter: neonate - 6 months
3.5mm
159
Uncuffed tube Diameter: 0.5-1.5 years
4mm
160
Uncuffed tube Diameter: >2 year old (formula)
age/4 + (4 or 4.5)
161
Formula for cuffed tube internal diameter: < 2 year old vs. > 2 year old
<2: Age (years)/ 4 + 3
>2: Age(years)/ 4 + 3.5
162
Formula practice: cuffed tube diameter for a 4 year old
Age(years) / 4 + 3.5
4/ 4 + 3.5= 4.5mm ID
163
Formula for lip to trachea distance for infants and children
10 + age(years) mm
164
Lip to trachea distance for neonate
6 cm for less than 1000g
7-9 cm for 1000-3000 g
165
LMA Size & Air Volume: up to 5kg neonate
Size 1, 4mL
166
LMA Size & Air Volume: 5-10kg
Size 1.5; 7mL
167
LMA Size & Air Volume: 10-20kg
Size 2; 10mL
168
LMA Size & Air Volume: 20-30 kg
Size 2.5; 14 mL
169
LMA Size & Air Volume: > 30 kg
Size 3; 20 mL
170
Formula for tube depth for kids > 1 year
(Age/2) + 12
171
Rank the methods of heat loss from most to least in pediatric patients
(Really cold, extra cute)
Radiation>convection>evaporation>conduction
*Conduction and Cute both have a "u"
172
For peds, OR temp should be increased to what temp?
80 deg F
173
What is the most effective strategy to minimize heat loss in children undergoing surgery for 1 hour or more?
Forced air warmer
174
Core temp is ideally measured how?
Esophageal temp probe
175
True or false: Nasopharyngeal probes tend to overrestimate the core temperature
False; underestimate based on cooler air passing through the breathing circuit
176
What is an induction dose of propofol for RSI in kids?
2-3 mg/kg
177
What is an induction dose of succ, atropine, and roc in kids for RSI?
Atropine 0.02mg/kg, followed by Succ 2mg/kg or Roc 0.8-1mg/kg
178
How much cricoid pressure should be applied in pediatric cricoid pressure compared to adults?
5N or 1/4 the pressure
179
What is "Troposmia"
a distorted perception of an odor - child is told that the flavor on the mask will transform into their favorite flavor with induction
180
Flavored facemask during induction is applied over the mouth and nose with ______L/min of _________% N2O until patient loses consciousness
5-7, 70-30
181
After child loses consciousness during induction, what comes next?
Ventilation is assissted, turn on 8% sevo and 70% N2O while IV is established
Then administer 1-2mg/kg IV propofol and stop N2O
After airway is controlled, reduce sevo to 2-3%
182
During induction, keep positive pressures < _____ cm H2O
15
183
How long before IV placement should EMLA cream be applied?
30-60 minutes
184
What is the best induction agent in cyanotic heart disease and shock?
ketamine
185
Etomidate is not recommended for children under _______ years old, and dose should __________ (increase/decreases) as age increases.
10; decrease
186
What type of fluid should be used for fluid replacement?
isotonic
187
What is an appropriate fluid bolus for suspected dehydration?
5-10 ml/kg over 10-30 minutes
188
What is the goal UOP?
0.5-1ml/kg/hr
189
If 10-20 cmH2O of PPV does not increase oxygen saturation after a desaturation episode, what should be suspected?
Laryngospasm
190
Afferent vs. Efferent pathway of laryngospasm
Afferent: SLN
Efferent: SLN to Cricothyroid(RLN)
191
4 steps to treating pediatric laryngospasm
1. 100% FiO2 with PPV 15-20 (good seal). Only squeeze the bag during a child's inspiratory effort
2. Remove triggering agent
3. Jaw thrust for 3-5 sec and release for 5-10
4. Atropine 0.02mg/kg, Propofol 1mg/kg, Succ 0.25-2mg/kg IV or 4-5 mg/kg IM
192
Where should the jaw thrust maneuvar be applied and why?>
Mastoid process (NOT angle of mandible) because it causes more pain and rotates the TMJ appropriately
193
What is considered bradycardia in the following age groups:
-<1 year
- 1-5 years
- >5 years
<1: <100bpm
1-5: <80 bpm
>5: 60 bpm
194
What is the main cause of bradycardia in children?
hypoxia
195
True or false: Atropine is effective when the bradycardia is not related to vagal response
F
196
Treatment and dose for asystole
10 mcg/kg Epi
197
Treatment for bronchospasm
1. Call for help and stop surgery
2. 100% FiO2 and manual ventilation
3. deepen anesthetic (IA or IV)
4. Albutoeral
5. Epi 10-20 mcg/kg; 1-4mcg/min drip
6. Bronchodilators (terbutaline 0.5mg, 2 g mag sulfate)
7. 0.25-1g Hydrocortisone
198
What two electrolyte imbalances commonly cause bradycardia in children?
Hyperkalemia, hypocalcemia
199
True or false: albuterol should be used for all children under 10 years old
False: not necessary for children > 8
200
LR is _________-tonic at _______ mOsM/L, while saline is _________-tonic at _________ mOsM/L
Hypo, 280
Iso, 308
201
What is the pH of normal saline?
5
202
What should be inlcuded in the fluids for infants < 6 months?
glucose
203
What is the newest fluid recommendation for children and why?
infuse 10ml/kg/hr of isotonic solution for each hour for 2-4 hours after induction to re-establish euvolemia and downregulate ADH
204
Rank the Dehydration (mild/mod/severe): poor skin turgor
mild
205
Rank the Dehydration (mild/mod/severe): sunken fontanel
mod
206
Rank the Dehydration (mild/mod/severe): tachycardia
mod
207
Rank the Dehydration (mild/mod/severe): sunken eyeballs
severe
208
Rank the Dehydration (mild/mod/severe): oliguria
mod
209
Rank the Dehydration (mild/mod/severe): dry mouth
mild
210
Rank the Dehydration (mild/mod/severe): anuria
severe
211
Rank the Dehydration (mild/mod/severe): hypotension
severe
212
What is the smallest gauge IV that blood can be rapidly transfused through?
22g
213
What is the transfusion threshold in children?
hgb 7
214
What is the EVB of premature infants?
95-100ml/kg
215
True or false: obese children have increased blood volume compared to non-obese children
false; it is reduced 10%
216
MABL calculation
(starting Hct - Target Hct) / starting Hct
217
How much blood is required to increased Hgb by 1%
2-5ml/kg PRBCs OR
6ml/kg whole blood
218
How long does a single shot caudal anesthetic last?
4-6hr
219
What ligament is pierced when placing a caudal?
sacrococcygeal ligament
220
True or false: negative pressure should be applied to the syringe/ catheter when placing a caudal
false- will cause veins to collapse
221
What are EKG signs of venous injection of a caudal?
peaked T, increased ST segments
222
What movement indicates good tone for extubation in infants?
Flexion of the hips
223
A rare but fatal arrhythmia may occur in children with undiagnosed congenital long QT syndrome. How can this be treated?
1-2mg/kg IV lidocaine
15-30mg/kg Magnesium & schock
224
What is the optimal position for patient transport to PACU? What is the most common reason for desaturation on transport?
Lateral decubitus
Upper airway obstruction
225
By what mechanism does post-extubation swelling cause stridor?
reduces cross-sectional diameter & increases pressure gradient and WOB
226
Post-extubation stridor is more common in what 2 conditions
1. down syndrome
2. recent URTIs
227
What is the treatment for post-operative stridor
1. humidified O2 100%
2 Sit patient up
3. light sedation
4. IV dexamethasone 0.6mg/kg
5. Racemic Epi 0.5mL in 2mL saline
6. Heliox (but this limits FiO2)
7. If hypoxemia occurs, re-intubate with smaller tube
228
What is pink frothy pulmonary edema often a sign of?
Neg. Pressure pulmonary edema
229
How does Furosemide help treat negative pressure pulmonary edema?
0.5-1mg/kg vasodilates the vasculature resolving pulmonary congestion/ improving oxygenation
230
What is the minimal acceptable SpO2 in children?
94%
231
Trachela mucosa perfusion pressure is _______cm H2O
25
232
Post-intubation croup (laryngeal edema) typically occurs how long after extubation?
30-60min
233
How does heliox help with post-intubation croup?
improves laminar airflow by reducing reynold's number
234
Patient's should be observed for __________ for a minimum of 4 hours after receiving racemic Epi
rebound edema
235
What age group is at highest risk for ED?
2-6 years
236
Which 2 IAs are highest risk for causing ED?
Sevo and Des (Sevo>)
237
True or false: to help prevent PONV, have child drink 8 oz of water 2 hours after anesthesia
false - do not force fluids. Pre-hydrate in OR and give PO fluids on upon child's request.
238
Name 4 pediatric procedures that are high risk for PONV
Strabismus
Tonsillectomy
Orchiopexy
Herniorrhaphy
Middle ear surgery
Laparotomy/Laparoscopy
239
PONV prophylaxis dose of Decadron
0.025-0.15 mg/kg, max 10mg
240
PONV prophylaxis dose of Ondansetron
0.05-0.15mg/kg, max 4mg
241
PONV prophylaxis dose of Metoclopramide
0.15mg/kg
242
A dose that is acceptable for decadron, zofran, and reglan for PONV prophylaxis is? What about Scopolamine?
0.15mg/kg
1.5 mg
243
Name that condition: most common mandibulofacial syndrome
Treacher collins
244
Name that condition: sensitive to opioids and NMBD
down syndrome
245
Name that condition: keep head in neutral position
down syndrome
246
Name that condition: awake and lateral extubation
cleft lip and palate
247
Epiglottitis vs. Croup: Thumb sign. What is that?
Epiglottitis - swollen epiglottis on xray
247
What are the 4D's of epiglottitis
1. drooling
2. dysphagia
3. dysphonia
4. dyspnea
248
In what position should the patient with epiglottitis be intubated?
sitting with NO nmbd
249
Epiglottitis vs. Croup: steeple sign. What is that?
Croup - narrowing of the upper airway
250
Epiglottitis vs. Croup: often bacterial (H. flu, Group A strep, Pneumo/Staphlococci)
Epiglottitis
251
Epiglottitis vs. Croup: often viral (H. Parainfluenza, RSV, Influenza type A and B)
Croup
252
If croup is bacterial (rare), what bacteria is often responsible?
mycoplasma pneyomniae
253
Epiglottitis vs. Croup: < 2 years
croup
254
Epiglottitis vs. Croup: 2-6 years
eppiglotitis
255
Epiglottitis vs. Croup: <24 hours - rapid
Epiglottitis
256
Epiglottitis vs. Croup: gradual (24-72 hours)
croup
257
Epiglottitis vs. Croup: Affects laryngeal structures
croup
258
Epiglottitis vs. Croup: affects supraglottic structures
epiglottitis
259
Epiglottitis vs. Croup: requires lateral xray
epiglottitis
260
Epiglottitis vs. Croup: requires frontal xray
croup
261
Epiglottitis vs. Croup: presents with mild fever
croup
262
Epiglottitis vs. Croup: presents with high fever
epiglottitis
263
Epiglottitis vs. Croup: presents with inspiratory stridor and barking cough
croup
264
Epiglottitis vs. Croup: tripod position helps breathing
epihlottitis
265
Epiglottitis vs. Croup: treated with corticosteroids
croup
266
Epiglottitis vs. Croup:treated with urgent airway management, and likely intubation
epiglottitis
267
Epiglottitis vs. Croup: treated with fluids
croup
268
What is the treatment for epiglottitis?
O2, airway management, intubate with spontaneous RR and 10-15 of CPAP
ENT surgeon present for possible trach
Abx if bacterial
269
What is the treatment for croup?
O2, racemic epi, steroids, humidification, fluids
270
What are some airway abnormalities seen with down syndrome?
Small mouth, large tongue
Narrow palate, high arch
midfact hypoplasia
AO subluxation at C1-C2
Subglottic stenosis - use small ETT
OSA
Chronic pulmonary infections
271
What 2 cardiac malformations are common in down syndrome
AV septal defect (most common)
VSD
272
True or false: down syndrome patients are at risk for bradycardia during Sevo induction? why?
True; low levels of circulating catecholamines
treat with anticholinergic
273
True or false: foreign bodies below the glottis are more likely to cause obstruction than in the larynx?
F
274
How quickly does CO2 rise in apneic infants and young children?
9mm Hg/minute
275
Why should you be careful positioning down syndrome patients?
they have hyperflexible joints
276
True or false: down syndrome patients have an increased incidence of leukemia
T
277
What is the class triad of foreign body aspiration symptoms in children?
1. cough
2. wheezing
3. decreased breath sounds over affected side (usually right)
278
What is the gold standard procedure to retrieve a foreign body?
rigid bronch
279
What does hyperventilation do to levels of calcium in the blood?
lowers them
