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NA 3 > Peds Quizlet > Flashcards

Peds Quizlet Flashcards

1
Q

Anatomical changes: head

A

larger occiput

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2
Q

Anatomical changes: respiration pattern

A

obligate nose breathers

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3
Q

Anatomical changes: Larynx. What vertebrae is it located at?

A

more cephalad - C3-C4

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4
Q

Anatomical changes: epiglottis

A

omega shaped and longer

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5
Q

Anatomical changes: vocal cords

A

slant caudally at arytenoid insertion

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6
Q

Anatomical changes: trachea

A

shorter, 4-5 cm

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7
Q

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

A

Cricoid ring

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8
Q

Anatomical changes: right mainstem bronchus

A

acute angle at the carina

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9
Q

Pediatric patients have turbulent gas flow until the ______th (#) bronchial division

A

5

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10
Q

Resistance is inversely related to _________ to the _______ power

A

radius; 5th

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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

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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

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13
Q

Anatomical changes: rib cage

A

increased compliance

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14
Q

anatomical changes: lung compliance. Why?

A

decreased - lack of elastin

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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

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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

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17
Q

Name that condition: Supraglottic structures converge on the glottic opening, leading to retractions, paradoxical chest movement, and exaggerated diaphragm excursion

A

Laryngomalacia

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18
Q

Name that condition: Micrognathia, airway distress, glossoptosis

A

Pierre Robin

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19
Q

Name that condition: airway becomes MORE difficult with age

A

Treacher collins

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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

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21
Q

What is the airway finding associated with both down syndrome and beckwith syndrome?

A

large tongue

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22
Q

What is the airway finding associated with “please get that chin” (pierre robin, goldenhar, treacher collings, cri du chat)

A

Small mandible

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23
Q

What is the airway finding associated with the acronym “kids try gold” (Klippel-feli, trisomy 21, goldenhar)

A

cervical spine anomaly

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24
Q

True or false: trisomy 21 patients often have large tongues and cervical spine anomalies

A

T

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25
Q

True or false: goldenhar patients often have small jaws and cervical spine anomalies

A

T

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26
Q

Name that condition: small smouth, small mandible, choanal atresia, eye and ear anomalies

A

Treacher Collins

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27
Q

Name that condition: small mouth, large tongue, atlantoaxial instability, small subglottic diameter

A

Trisomy 21

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28
Q

Name that condition: small mandible/ micrognathia, tonge that falls back and downwards (glossoptosis)

A

pierre robin

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29
Q

Name that condition: small mandible, laryngomalacia, stridor

A

Cri du chat

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30
Q

Increase/ Decrease in Peds: atelectasis risk

A

increase

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31
Q

Increase/ Decrease in Peds: O2 reserve and FRC

A

decrease

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32
Q

Increase/ Decrease in Peds: PNS activity

A

relative increase

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33
Q

Increase/ Decrease in Peds: SV compensation/ SVR tone

A

decrease

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34
Q

Increase/ Decrease in Peds: CBF? What is normal?

A

increase - normal is 70-110ml/100g of brain/min

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35
Q

Increase/ Decrease in Peds: CMRO2? What is normal?

A

increase - 5.5ml/100g/min

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36
Q

Increase/ Decrease in Peds: Autoregulation

A

no change

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37
Q

Increase/ Decrease in Peds: pH of gastric juice

A

increase (less acidic)

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38
Q

Increase/ Decrease in Peds: Albumin and Alpha-1 Glycoprotein. Which one binds to basic drugs?

A

decrease - Alpha 1 binds to basic

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39
Q

Increase/ Decrease in Peds: GFR

A

decrease

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40
Q

Why is CO so heart rate dependent in pediatric patients?

A

There is reduced ability to compensate by increases stroke volume

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41
Q

Atropine increases CO in peds patients in 2 ways, what are they?

A
  1. increasing HR
  2. augmenting calcium force
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42
Q

Normal HR and BP: 0-3 months

A

HP: 100-150
BP: 60-85/ 45-55

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43
Q

Normal HR and BP: 3-6 months

A

HR: 90-120
BP: 70-90/ 50-65

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44
Q

Normal HR and BP: 6-12 months

A

HR: 80-120
BP: 80-100/ 55-65

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45
Q

Normal HR and BP: 1-3 years

A

HR: 70-110
BP: 90-105/ 55-70

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46
Q

Normal HR and BP: 3-6 years

A

HR: 65-110
BP: 95-110/60-75

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47
Q

Normal HR and BP: 6-12 years

A

HR: 60-95
BP: 100-120/60-75

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48
Q

Normal HR and BP: >12 years

A

HR: 55-85
BP: 110-135/ 65-85

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49
Q

Increase or decrease in peds: O2 consumption - what is normal?

A

increase - 5.5ml/100g/min

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50
Q

CBF in children is directed largely towards ________ matter

A

gray

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51
Q

Drugs that act on NMDA/GABA receptors cause _______ in children. What can help reduce these effects?

A

Apoptosis (programmed cell death)
Helps: melatonin, lithium, hypothermia, exercise

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52
Q

True or false: rectal drugs can undergo first-pass metabolism

A

True- if they are absorbed via rectal superior veins which drain into the portal venous system

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53
Q

The free fraction of lidocaine will be greater in __________ (younger/older) children. Why?

A

Younger - decreased Alpha 1 Glycoprotein which binds to basic drugs - increases with age

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54
Q

Phase 1 or Phase 2:
-Hydroxylation
-Oxidation
-Glucoronidation

A

Hydrox.: 1
Ox: 1
Gluco: 2

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55
Q

True or false: The liver does not metabolize drugs well at birth because it is lacking the CYP enzymes needed to do so?

A

False - enzymes are present but not mature enough (they have not been induced)

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56
Q

Which enzyme metabolizes 50% of drugs?

A

CYP450 3A4

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57
Q

4 reasons why inhalation induction is faster in pediatric patients?

A
  1. increased alveolar ventilation: FRC ratio
  2. Greater distribution of CO to vessel rich group
  3. Reduced tissue solubility
  4. Reduced blood solubility
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58
Q

Does this effect the wash-IN (lung delivery) or wash-OUT (anesthetic removal) of inhaled agents: Inspired concentation

A

wash-in

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59
Q

Does this effect the wash-IN (lung delivery) or wash-OUT (anesthetic removal) of inhaled agents: alveolar ventilation to FRC ratio

A

wash-in

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60
Q

Does this effect the wash-IN (lung delivery) or wash-OUT (anesthetic removal) of inhaled agents: Blood gas solubility

A

wash out

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61
Q

Does this effect the wash-IN (lung delivery) or wash-OUT (anesthetic removal) of inhaled agents: cardiac output

A

wash out

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62
Q

Does this effect the wash-IN (lung delivery) or wash-OUT (anesthetic removal) of inhaled agents: alveolar-venous partial pressure gradient

A

wash out

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63
Q

What is the inhaled agent of choice in pediatrics and why?

A

sevoflurane - less airway irritation

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64
Q

Changes in alveolar ventilation and cardiac output affect the wash-in of __________(less/more) soluble anesthetics to a greater extent?

A

more
(Nagelhout highway example - the slow cars are going to feel the speed-up more than the fast cars)

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65
Q

Wash-in of ______ solubility anesthetics (high/low) are similar between peds and adults?

A

low

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66
Q

Order these from least soluble to most soluble: Sevo, Iso, Halothane, Des

A
  1. Des
  2. Sevo
  3. Iso
  4. halothane
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67
Q

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).

A

Negative; positive

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68
Q

Explain the “negative feedback” of inhaled induction with spontaneous ventilation

A

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

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69
Q

Explain the “positive feedback” of inhaled induction with controlled ventilation?

A

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

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70
Q

A cardiac shunt in which direction greatly impacts wash-in of low solubility inhalation agents? how?

A

Right to left
Because blood is bypassing the lungs, therefore not interacting with the inhaled agent in the alveoli

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71
Q

At what age does MAC peak?

A

1-6 months

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72
Q

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?

A

decreased - 60% O2 only contributes 25% to the MAC value

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73
Q

One degree drop in a child’s temperature will decrease his/her MAC by _______%

A

5

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74
Q

What does sevoflurane do to cardiac index?

A

Decreases is by 10% at 1 MAC, 20-30% at 2 MAC

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75
Q

What does IA’s do to tidal volume and respiratory rate? What about minute ventilation?

A

Decreased tidal volume
Increase RR
Decrease MV

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76
Q

What do IAs do to the response to CO2 and hypoxia?

A

Decrease it

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77
Q

Airway resistance __________(increases/decreases) with Des, and ___________ (increases/decreases) with Sevo.

A

Increases; decreaeses

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78
Q

What do do IAs do to QT interval?

A

Prolong it (>500 msec)

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79
Q

Patients with low values of what 4 labs are at increased risk for torsades?

A
  1. mag
  2. potassium
  3. calcium
  4. thyroid hormone (T3/T4)
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80
Q

True or false: Tachycardia puts the patient at increased risk for torsades with prolonged QT from IAs?

A

False; bradycardia

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81
Q

True or false: Male gender puts the patient at increased risk for torsades with prolonged QT from IAs?

A

False; female

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82
Q

Which IA uncouples CBF/CMRO2 the LEAST in children?

A

Sevo (followed by Iso, then Des)

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83
Q

BIS is not precise under the age of ______

A

5yr

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84
Q

True or false: Sevoflurane at 1 MAC impairs autoregulation in children

A

false - only > 1.5 MAC

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85
Q

How can the anesthetist help repair autoregulation that has been impaired by high concentrations of Iso or Sevo

A

hyperventilation

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86
Q

Vd and clearance of propofol _________(increase/decrease) during early childhood

A

decrease

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87
Q

True or false: propofol should be avoided in children with an egg allergy (per Barash)

A

True- kinda- only in egg ANAPHYLAXIS

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88
Q

What is an effective blood concentration of Ketamine for anesthesia?

A

3 mcg/mL

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89
Q

IV, IM, and PO doses of ketamine

A

IV: 1-2 mg/kg
IM: 2-5 mg/kg
PO: 5-6 mg/kg

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90
Q

How long does it take IM ketamine to onset? When does it peak?

A

Onset 3-5 min, peak 30-40

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91
Q

Appropriate dose of Etomidate in children?

A

0.3 mg/kg

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92
Q

What is the neonatal infant dose of succinycholine and why? What about children?

A

Neonate: 3-4 mg/kg due to larger Vd
Children: 2 mg/kg

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93
Q

What is the most common pediatric side effect of succinylcholine? Why? How can you prevent it?

A

bradycardia - ACh activation of vagal nerves
Pre-treat with 10/20 mcg/kg of atropine or 5-10 mcg/kg of glyco

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94
Q

How can you treat Hyperkalemia caused by succinylcholine and how does this work?

A

10mg/kg CaCl - raises threshold potential to prevent arrhythmias

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95
Q

How much does IOP increase with succinylcholine and when does it peak?

A

7-10 mm Hg, peaks in 1-2 min

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96
Q

What kind of children are at risk for muscle pain after succ and how can you prevent this?

A

Muscular adolescents - pre-treat with NDMB

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97
Q

What is the earliest sign of MH

A

increase in ETCO2 accompanied by and increase in RR and low SpO2

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98
Q

Dantrolene dose

A

2.5 mg/kg
repeated q5-10 min

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99
Q

True or false: Roc is exclusively eliminated by the liver

A

T

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100
Q

Potency of rocuronium is greatest in what age group and the least in what age group?

A

Greatest in infants, least in children?

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101
Q

What commonly used anesthetic agent potentiates the effect of rocuronium?

A

sevo

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102
Q

Rocuronium dose in infants vs. children

A

Infants: 0.25mg/kg
Children: 0.4-0.6 mg/kg

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103
Q

Increase or decrease in peds: dose of Neostigmine

A

decrease - dose is 30-40% of adult dose
20-40 mcg/kg up to 70 mcg/kg

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104
Q

Neostigmine dose of > _______ mcg/kg may cause ACh associated weakness

A

100

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105
Q

Fentanyl is ______ soluble (lipid/water), and primarily bound to ________(albumin/ AAG)

A

lipid, AAG

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106
Q

What is an IV dose of fentanyl appropriate for pediatric patients?

A

Minor: 1-3 mcg/kg
Major: 12-50 mcg/kg

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107
Q

What is an appropriate pediatric dose of Meperidine for shivering?

A

0.5-1 mg/kg

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108
Q

Black box warning for codeine is for what?

A

Respiratory depression

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109
Q

Ibuprofen vs. Acetaminophen dosing

A

Acetaminophen: 10-15 mg/kg PO; 20-40 mg/kg PR
Ibuprofen: 10-15mg/kg PO

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110
Q

Midazolam is ______ soluble (water/lipid)

A

water

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111
Q

IV vs. Nasal versed dosing

A

IV: 0.1-0.2 mg/kg
Nasal: 0.2-0.3 mg/kg

How well did you know this?
1
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2
3
4
5
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112
Q

True or false: Precedex has hemodynamic manifestations via direct AND indirect action on the SNS

A

T

How well did you know this?
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2
3
4
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113
Q

What is the appropriate IV loading dose and infusion rate of precedex?

A

Load: 1 mcg/kg over 10 minutes
Drip: 0.3-0.7 mcg/kg/HOUR (not minute)

114
Q

What effect does precedex have on the MAC of IAs?

A

decreases it by 30%

115
Q

True or false: bradycardia from precedex should be immediately treated with glyco

A

false - this may lead to HTN

116
Q

Perioperative cardiac arrest in pediatrics is a higher risk in what 3 types of patients?

A

<1 year, CHD, or emergent surgical patients

117
Q

What should you tell your patient’s parents if they ask whether or not general anesthesia can cause brain dysfunction?

A

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
Q

True or false: there is a cross-sensitivity between and PCN allergy and Cefazolin?

A

True - cefazolin is a first-generation cephalosporin

119
Q

If a child’s PCN allergy is >5 years ago, what can you offer to do for the parent?

A

Test-dose them while monitoring

120
Q

Children who have ingested solid food within _______ hours of trauma are at risk for aspiration?

A

8

121
Q

True or false: If a child presents with gum, the surgery must be cancelled

A

False - they have to spit it out

122
Q

What happens to gastric volume and pH after chewing gum?

A

Volume is doubled, no change in pH

123
Q

Tures or false: Obesity in children increases the risk of pneumonitis with aspiration?

A

False - obesity, like gum, increases gastric volume but gastric pH is unchanged

124
Q

True or false: children with type 1 DM are considered to have gastroparesis

A

false - takes years to develop

125
Q

NPO guidelines:
-clear liquids
-Breast milk
-infant formula/cow’s milk
-solid food

A

Clear: 2 hours
BM: 4 hours
Formula/Dairy milk: 6 hours
Solid: 8 hours

126
Q

Hgb should be drawn pre-op on children of what age?

A

< 6 months, or < 1 year if premature

127
Q

Pregnancy tests are often done in female children age ______ and older

A

10

128
Q

What pulmonary sound would alert the anesthetist that the child should receive a CXR and pulm. consult?

A

Rales/rhonchi that do NOT clear with coughing

129
Q

Name 5 pre-op respiratory assessment points that are unique to kids

A

URI
Smoke exposure
Hx of BPD, tracheo or larnygomalacia
Nasal flaring
color of mucous membranes

130
Q

What drug displaces billirubin and puts patients at increased risk for surgical bleeding?

A

Indomethacin

131
Q

What drug puts patients at risk for seizures, HoTN, cerebral irritability, and pyrexia?

A

Prostaglandins

132
Q

What drug may cause rebound PPHN with withdrawal?

A

Prostacyclin

133
Q

What is the leading cause of case cancellation in children?

A

URI

134
Q

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.

A

4;6

135
Q

If children come in with a clear runny nose, what can you do?

A

Dilute neosynephrine to 0.25% and drop in nose to dry secretions

136
Q

True or false: for a patient with high risk of airway reaction, and ETT is the less triggering device

A

false- LMA is less likely to trigger a response than an ETT

137
Q

4 criteria for case cancellation with URTI:

A
  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
Q

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?

A
  1. Asthma
  2. < 1 year old
  3. sickle cell disesase
139
Q

Mechanical irritation with an ETT increases the risk of bronchospasm by _______-fold

A

10

140
Q

Dexamethasone dose of ___________mg/kg will reduce the risk of croup

A

0.25-0.5

141
Q

True or false: pre-treatment with a bronchodilator reduces the risk of airway issues

A

F

142
Q

What medication and dose may be administered intra-operatively to reduce post-operative apnea? What puts patients at high risk for post-operative apnea?

A

Caffeine 10mg/kg IV
Former prematurity, < 60 weeks post-conception, Hgb <12%, secondary diagnosis

143
Q

What type of temperature monitoring is preferred in pediatric MH and why?

A

Axillary - reflects the temp in the largest muscle bulk in the chest

144
Q

True or false: daytime somnolence is required to diagnose OSA in children

A

False- it is not a common symptom

145
Q

Children with OSA who have a minimum nocturnal SpO2 of _______% are at risk for ________________ sensititivy

A

85; opioid

146
Q

3 triggering factors of a sickle cell crisis

A

hypoxia, hypovolemia, hypothermia

147
Q

Obesity in children is considered to be > _______ percentile

A

95th

148
Q

Parental presence during induction should not be used for children under ______ months old

A

8

149
Q

Younger children would require a _________(higher/lower) dose of PO versed as compared to older children. Why?

A

Higher; poor bioavailability

150
Q

What gauge needle should be attached to your emergency atropine and succinylcholine?

A

23 or 25g

151
Q

Recommended blade: Neonate

A

Miller 0

152
Q

Recommended blade: 1-2 years

A

Miller/Mac 1; WH 1

153
Q

Recommended blade: 3-4 years

A

WH 1.5

154
Q

Recommended blade: > 4 years

A

Miller 2

155
Q

Recommended blade: 3-5 years

A

Mac 2

156
Q

Uncuffed tube Diameter: <1500 g neonate

A

2.5mm

157
Q

Uncuffed tube Diameter: 1500 g- full term neonate

A

3mm

158
Q

Uncuffed tube Diameter: neonate - 6 months

A

3.5mm

159
Q

Uncuffed tube Diameter: 0.5-1.5 years

A

4mm

160
Q

Uncuffed tube Diameter: >2 year old (formula)

A

age/4 + (4 or 4.5)

161
Q

Formula for cuffed tube internal diameter: < 2 year old vs. > 2 year old

A

<2: Age (years)/ 4 + 3
>2: Age(years)/ 4 + 3.5

162
Q

Formula practice: cuffed tube diameter for a 4 year old

A

Age(years) / 4 + 3.5
4/ 4 + 3.5= 4.5mm ID

163
Q

Formula for lip to trachea distance for infants and children

A

10 + age(years) mm

164
Q

Lip to trachea distance for neonate

A

6 cm for less than 1000g
7-9 cm for 1000-3000 g

165
Q

LMA Size & Air Volume: up to 5kg neonate

A

Size 1, 4mL

166
Q

LMA Size & Air Volume: 5-10kg

A

Size 1.5; 7mL

167
Q

LMA Size & Air Volume: 10-20kg

A

Size 2; 10mL

168
Q

LMA Size & Air Volume: 20-30 kg

A

Size 2.5; 14 mL

169
Q

LMA Size & Air Volume: > 30 kg

A

Size 3; 20 mL

170
Q

Formula for tube depth for kids > 1 year

A

(Age/2) + 12

171
Q

Rank the methods of heat loss from most to least in pediatric patients

A

(Really cold, extra cute)
Radiation>convection>evaporation>conduction
*Conduction and Cute both have a “u”

172
Q

For peds, OR temp should be increased to what temp?

A

80 deg F

173
Q

What is the most effective strategy to minimize heat loss in children undergoing surgery for 1 hour or more?

A

Forced air warmer

174
Q

Core temp is ideally measured how?

A

Esophageal temp probe

175
Q

True or false: Nasopharyngeal probes tend to overrestimate the core temperature

A

False; underestimate based on cooler air passing through the breathing circuit

176
Q

What is an induction dose of propofol for RSI in kids?

A

2-3 mg/kg

177
Q

What is an induction dose of succ, atropine, and roc in kids for RSI?

A

Atropine 0.02mg/kg, followed by Succ 2mg/kg or Roc 0.8-1mg/kg

178
Q

How much cricoid pressure should be applied in pediatric cricoid pressure compared to adults?

A

5N or 1/4 the pressure

179
Q

What is “Troposmia”

A

a distorted perception of an odor - child is told that the flavor on the mask will transform into their favorite flavor with induction

180
Q

Flavored facemask during induction is applied over the mouth and nose with ______L/min of _________% N2O until patient loses consciousness

A

5-7, 70-30

181
Q

After child loses consciousness during induction, what comes next?

A

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
Q

During induction, keep positive pressures < _____ cm H2O

A

15

183
Q

How long before IV placement should EMLA cream be applied?

A

30-60 minutes

184
Q

What is the best induction agent in cyanotic heart disease and shock?

A

ketamine

185
Q

Etomidate is not recommended for children under _______ years old, and dose should __________ (increase/decreases) as age increases.

A

10; decrease

186
Q

What type of fluid should be used for fluid replacement?

A

isotonic

187
Q

What is an appropriate fluid bolus for suspected dehydration?

A

5-10 ml/kg over 10-30 minutes

188
Q

What is the goal UOP?

A

0.5-1ml/kg/hr

189
Q

If 10-20 cmH2O of PPV does not increase oxygen saturation after a desaturation episode, what should be suspected?

A

Laryngospasm

190
Q

Afferent vs. Efferent pathway of laryngospasm

A

Afferent: SLN
Efferent: SLN to Cricothyroid(RLN)

191
Q

4 steps to treating pediatric laryngospasm

A
  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
Q

Where should the jaw thrust maneuvar be applied and why?>

A

Mastoid process (NOT angle of mandible) because it causes more pain and rotates the TMJ appropriately

193
Q

What is considered bradycardia in the following age groups:
-<1 year
- 1-5 years
- >5 years

A

<1: <100bpm
1-5: <80 bpm
>5: 60 bpm

194
Q

What is the main cause of bradycardia in children?

A

hypoxia

195
Q

True or false: Atropine is effective when the bradycardia is not related to vagal response

A

F

196
Q

Treatment and dose for asystole

A

10 mcg/kg Epi

197
Q

Treatment for bronchospasm

A
  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
Q

What two electrolyte imbalances commonly cause bradycardia in children?

A

Hyperkalemia, hypocalcemia

199
Q

True or false: albuterol should be used for all children under 10 years old

A

False: not necessary for children > 8

200
Q

LR is _________-tonic at _______ mOsM/L, while saline is _________-tonic at _________ mOsM/L

A

Hypo, 280
Iso, 308

201
Q

What is the pH of normal saline?

A

5

202
Q

What should be inlcuded in the fluids for infants < 6 months?

A

glucose

203
Q

What is the newest fluid recommendation for children and why?

A

infuse 10ml/kg/hr of isotonic solution for each hour for 2-4 hours after induction to re-establish euvolemia and downregulate ADH

204
Q

Rank the Dehydration (mild/mod/severe): poor skin turgor

A

mild

205
Q

Rank the Dehydration (mild/mod/severe): sunken fontanel

A

mod

206
Q

Rank the Dehydration (mild/mod/severe): tachycardia

A

mod

207
Q

Rank the Dehydration (mild/mod/severe): sunken eyeballs

A

severe

208
Q

Rank the Dehydration (mild/mod/severe): oliguria

A

mod

209
Q

Rank the Dehydration (mild/mod/severe): dry mouth

A

mild

210
Q

Rank the Dehydration (mild/mod/severe): anuria

A

severe

211
Q

Rank the Dehydration (mild/mod/severe): hypotension

A

severe

212
Q

What is the smallest gauge IV that blood can be rapidly transfused through?

A

22g

213
Q

What is the transfusion threshold in children?

A

hgb 7

214
Q

What is the EVB of premature infants?

A

95-100ml/kg

215
Q

True or false: obese children have increased blood volume compared to non-obese children

A

false; it is reduced 10%

216
Q

MABL calculation

A

(starting Hct - Target Hct) / starting Hct

217
Q

How much blood is required to increased Hgb by 1%

A

2-5ml/kg PRBCs OR
6ml/kg whole blood

218
Q

How long does a single shot caudal anesthetic last?

A

4-6hr

219
Q

What ligament is pierced when placing a caudal?

A

sacrococcygeal ligament

220
Q

True or false: negative pressure should be applied to the syringe/ catheter when placing a caudal

A

false- will cause veins to collapse

221
Q

What are EKG signs of venous injection of a caudal?

A

peaked T, increased ST segments

222
Q

What movement indicates good tone for extubation in infants?

A

Flexion of the hips

223
Q

A rare but fatal arrhythmia may occur in children with undiagnosed congenital long QT syndrome. How can this be treated?

A

1-2mg/kg IV lidocaine
15-30mg/kg Magnesium & schock

224
Q

What is the optimal position for patient transport to PACU? What is the most common reason for desaturation on transport?

A

Lateral decubitus
Upper airway obstruction

225
Q

By what mechanism does post-extubation swelling cause stridor?

A

reduces cross-sectional diameter & increases pressure gradient and WOB

226
Q

Post-extubation stridor is more common in what 2 conditions

A
  1. down syndrome
  2. recent URTIs
227
Q

What is the treatment for post-operative stridor

A
  1. humidified O2 100%
    2 Sit patient up
  2. light sedation
  3. IV dexamethasone 0.6mg/kg
  4. Racemic Epi 0.5mL in 2mL saline
  5. Heliox (but this limits FiO2)
  6. If hypoxemia occurs, re-intubate with smaller tube
228
Q

What is pink frothy pulmonary edema often a sign of?

A

Neg. Pressure pulmonary edema

229
Q

How does Furosemide help treat negative pressure pulmonary edema?

A

0.5-1mg/kg vasodilates the vasculature resolving pulmonary congestion/ improving oxygenation

230
Q

What is the minimal acceptable SpO2 in children?

A

94%

231
Q

Trachela mucosa perfusion pressure is _______cm H2O

A

25

232
Q

Post-intubation croup (laryngeal edema) typically occurs how long after extubation?

A

30-60min

233
Q

How does heliox help with post-intubation croup?

A

improves laminar airflow by reducing reynold’s number

234
Q

Patient’s should be observed for __________ for a minimum of 4 hours after receiving racemic Epi

A

rebound edema

235
Q

What age group is at highest risk for ED?

A

2-6 years

236
Q

Which 2 IAs are highest risk for causing ED?

A

Sevo and Des (Sevo>)

237
Q

True or false: to help prevent PONV, have child drink 8 oz of water 2 hours after anesthesia

A

false - do not force fluids. Pre-hydrate in OR and give PO fluids on upon child’s request.

238
Q

Name 4 pediatric procedures that are high risk for PONV

A

Strabismus
Tonsillectomy
Orchiopexy
Herniorrhaphy
Middle ear surgery
Laparotomy/Laparoscopy

239
Q

PONV prophylaxis dose of Decadron

A

0.025-0.15 mg/kg, max 10mg

240
Q

PONV prophylaxis dose of Ondansetron

A

0.05-0.15mg/kg, max 4mg

241
Q

PONV prophylaxis dose of Metoclopramide

A

0.15mg/kg

242
Q

A dose that is acceptable for decadron, zofran, and reglan for PONV prophylaxis is? What about Scopolamine?

A

0.15mg/kg
1.5 mg

243
Q

Name that condition: most common mandibulofacial syndrome

A

Treacher collins

244
Q

Name that condition: sensitive to opioids and NMBD

A

down syndrome

245
Q

Name that condition: keep head in neutral position

A

down syndrome

246
Q

Name that condition: awake and lateral extubation

A

cleft lip and palate

247
Q

Epiglottitis vs. Croup: Thumb sign. What is that?

A

Epiglottitis - swollen epiglottis on xray

247
Q

What are the 4D’s of epiglottitis

A
  1. drooling
  2. dysphagia
  3. dysphonia
  4. dyspnea
248
Q

In what position should the patient with epiglottitis be intubated?

A

sitting with NO nmbd

249
Q

Epiglottitis vs. Croup: steeple sign. What is that?

A

Croup - narrowing of the upper airway

250
Q

Epiglottitis vs. Croup: often bacterial (H. flu, Group A strep, Pneumo/Staphlococci)

A

Epiglottitis

251
Q

Epiglottitis vs. Croup: often viral (H. Parainfluenza, RSV, Influenza type A and B)

A

Croup

252
Q

If croup is bacterial (rare), what bacteria is often responsible?

A

mycoplasma pneyomniae

253
Q

Epiglottitis vs. Croup: < 2 years

A

croup

254
Q

Epiglottitis vs. Croup: 2-6 years

A

eppiglotitis

255
Q

Epiglottitis vs. Croup: <24 hours - rapid

A

Epiglottitis

256
Q

Epiglottitis vs. Croup: gradual (24-72 hours)

A

croup

257
Q

Epiglottitis vs. Croup: Affects laryngeal structures

A

croup

258
Q

Epiglottitis vs. Croup: affects supraglottic structures

A

epiglottitis

259
Q

Epiglottitis vs. Croup: requires lateral xray

A

epiglottitis

260
Q

Epiglottitis vs. Croup: requires frontal xray

A

croup

261
Q

Epiglottitis vs. Croup: presents with mild fever

A

croup

262
Q

Epiglottitis vs. Croup: presents with high fever

A

epiglottitis

263
Q

Epiglottitis vs. Croup: presents with inspiratory stridor and barking cough

A

croup

264
Q

Epiglottitis vs. Croup: tripod position helps breathing

A

epihlottitis

265
Q

Epiglottitis vs. Croup: treated with corticosteroids

A

croup

266
Q

Epiglottitis vs. Croup:treated with urgent airway management, and likely intubation

A

epiglottitis

267
Q

Epiglottitis vs. Croup: treated with fluids

A

croup

268
Q

What is the treatment for epiglottitis?

A

O2, airway management, intubate with spontaneous RR and 10-15 of CPAP
ENT surgeon present for possible trach
Abx if bacterial

269
Q

What is the treatment for croup?

A

O2, racemic epi, steroids, humidification, fluids

270
Q

What are some airway abnormalities seen with down syndrome?

A

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
Q

What 2 cardiac malformations are common in down syndrome

A

AV septal defect (most common)
VSD

272
Q

True or false: down syndrome patients are at risk for bradycardia during Sevo induction? why?

A

True; low levels of circulating catecholamines
treat with anticholinergic

273
Q

True or false: foreign bodies below the glottis are more likely to cause obstruction than in the larynx?

A

F

274
Q

How quickly does CO2 rise in apneic infants and young children?

A

9mm Hg/minute

275
Q

Why should you be careful positioning down syndrome patients?

A

they have hyperflexible joints

276
Q

True or false: down syndrome patients have an increased incidence of leukemia

A

T

277
Q

What is the class triad of foreign body aspiration symptoms in children?

A
  1. cough
  2. wheezing
  3. decreased breath sounds over affected side (usually right)
278
Q

What is the gold standard procedure to retrieve a foreign body?

A

rigid bronch

279
Q

What does hyperventilation do to levels of calcium in the blood?

A

lowers them

NA 3 (8 decks)

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