Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AA1 > peds week 2b > Flashcards

peds week 2b Flashcards

1
Q

What does NPO do to mucosa in peds?

A

sticky

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Deciduous teeth erupt at ___ months and begin shedding between ____ years

A

6 months and 6-8 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

larynx located in ped

A

c3-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

adult larynx located

A

c4-5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

shape of ped airway

A

funnel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

length of trachea(vocal cords to carina) in neonates and children up to one year of age

A

5-9cm or 2-2.5 inches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

____ to ____ cm H2O should leak

A

15-25

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

is the hyoepiglotic ligament formed in peds?

A

No, so cannot compress with mac blade to move epiglottis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Infants are obligate nasal breathers until how many months? and why?

A

3-5months because the major source of resistance to airflow is the lower airways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

overcoming the resistance of the nares accounts for ___% of the work of breathing for infants as compared to ___% in adults

A

25%, 60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

children less than 6 months rely on what type of breathing primarily?

A

diaphragmatic breathing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

diaphragm contains smaller percentage of what type of muscle fibers?

A

Type 1, (slow twitch, fatigues resistant)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what age does ribe cage contribution increase to 50%

A

9 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What age does chest wall become stable and resists inward recoil of lungs?

A

12 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Infant respiratory rate

A

30-50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Infant tidal volume

A

7mL/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Dead space infant

A

2-2.5mL/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Infant Alveolar ventilation

A

100-150mL/kg/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Functional residual capacity infant

A

27-30mL/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Infant oxygen consumption

A

7-9mL/kg/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how does anesthesia reduce FRC

A

causes peripheral airway collapse and impaired intercostal and diaphragm activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

ETT calculation

A

(age in years + 16)/4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

At what pressure should there be an audible air leak around tube

A

15-25cmH2O

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

post operative croup has been found to be caused by _______ more than any other factor

A

excessive tube size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Canceled cases reasons

A

wheezing,
green nasal drainage,
fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

increased risk of bronchospasm with

A

URI in past 2-6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

contraction of what adductor muscles of larynx causes laryngospasm

A

lateral cricoarytenoids, thyroarytenoids, and cricoarytenoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

stimulation of what nerve causes laryngospasm

A

superior laryngeal nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

causes of laryngospasm

A

inhalation of volatile agents,
excessive secretions in the airway,
presence of URI(hyper-irritable),
manipulation of the airway (intubation, extubation),
stimulation of the visceral nerve endings in the pelvis, abdomen, and thorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Treatment of laryngospasm

A
  1. remove irritating stimulus (suction),
  2. remove debris from airway,
  3. deepen anesthesia as appropriate,
  4. 100% O2 via tight fitting face mask,
  5. Sustained positive airway pressure (30-40cmH2O),
  6. manual forward displacement of mandible,
  7. if airway maneuvers fail-atropine, succs, and consider intubation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

atropine and succs dose for laryngospasm

A

Succs- 0.4mgkg IV and 4mg/kg IM

Atropine 20mcg/kg IM/IV

32
Q

Age greatest incidence of post intubation laryngeal edema

A

ages 1-4

33
Q

causes of post intubation laryngeal edema

A

mechanical trauma to the airway during intubation,

placement of a tube that produces a tight fit (no leak up to 40cm H2O)

34
Q

treatment of post intubation laryngeal edema

A
  1. humidification of inspired gases,
  2. aerosolized racemic epi 0.5mL of 2.25% solution in 2-3mL saline- vasoconstriction of capillaires in subglottic mucosa,
  3. re-intubation
  4. tracheostomy
35
Q

etiology of epiglottitis

A

haemophilus influenzae type B

36
Q

age epiglottitis occurs

A

3-6 years

37
Q

pathology of epiglottitis

A

systemic septicemic process with local eythema and edema most marked in the epiglottis, aryepiglottic folds, and supraglottic connective tissue

38
Q

symptoms of epiglottitis

A

rapid clinical progression of symptoms <24hrs,

dysphgia, dysphonia, drooling, inspirtory stridor, distress, high fever >39C

39
Q

treatment epiglottitis

A 
O2,
urgent intubation of the trachea under general-NEED to be in the OR(ENT present),
Antibiotics,
antipyretics,
fluids
40
Q

anesthetic management epiglottitis

A

do nothing to upset or agitate child,
smooth controlled induction with sevo, CPAP applied to circuit,
obtain Iv access and give atropine,
achieve stage III, do not precipitate laryngospasm, size and a half smaller ETT,
MAINTAIN SPONT VENT, direct laryngoscopy by ENT to confirm diagnosis

41
Q

epiglottitis anesthetic implications

A

slow induction d/t partially obstructed airway,
inflammation of airway may enhance irritability increasing potential for coughing, breathholding, and laryngospasm.
CV depressant effects of inhale agent magnified r/t hypovolemia.

42
Q

what accounts for 90% of infectious airway obstruction in children?

A

laryngotracheobronchitis (croup, subglottic infection)

43
Q

etiology of laryngotracheobronchitis

A

parainfluenzae virus type 1 and 2, influenzae A, respiratory syncytial virus

44
Q

Pathology of laryngotracheobronchitis and children age

A

mucosal and submucosal edema within the cricoid ring (decreased luminal size) age <2 years

45
Q

Onset of larygotracheobronchitis

A

gradual onset of symptoms 24-72 hours. hx of URI progressing to hoarse cry or barking cough, low grade fever <39

46
Q

treatment of croup

A
  1. O2 w/ cool aqueus mist,
  2. Recemic epi (vasoconstriction of capillaries in subglottic mucosa, Beta adrenergic bronchodilatory effect) Albuterol,
  3. Corticosteroids? Stabilize cell membrane integrity, decrease release of inflammatory mediators,
  4. antipyretics
  5. intubation of the trachea is RARE unless exhaustion occurs
47
Q

Most frequent site of foreign body aspiration

A

right mainstem

48
Q

Levels of airway obstruction

A

distal airway, mainstem bronchus, trachea, larynx

49
Q

S/S of foreign body aspiration

A

cough, wheezing, decreased air entry into affected lung, URI, pneumonia

50
Q

Treatment of foreign body aspiration

A

laryngoscopic or endoscopic removal,
best to remove within 24 hr,
risks of leaving foreign object-> migration of aspirated material, pneumonia, residual pulmonary disease

51
Q

anesthetic management foreign body

A

with airway obstruction- inhalation of volatile agent in O2 maintaining spontaneous ventilation,
without airway obstruction- IV induction with standard agents

52
Q

What do you want to avoid with airway obstruction?

A

NDNMBs,
positive pressure may migrate aspiration material,
narrow bronchoscope creates high resistance to gas flow,
typically there is a large gas leak around the bronchoscope

53
Q

what may be required if removal of aspirate object is too large to pass through moving cords?

A

succs, cisatracurium

54
Q

post op of removal of foreign body

A

racemic epic, corticosteroids to reduce subglottic edema, pt may or may not be intubated

55
Q

foreign body aspiration complications

A 
airway obstruction, 
fragmentation of foreign body,
arterial hypoxemia,
hypercarbia,
subglottic edema from trauma to the tracheobronchial tree - foreign body, instrumentation
56
Q

tonsillectomy and adenoidectomy clinical implications

A

upper airway obstruction,
massive hypertrophy,
chronic upper resp infections,
OSA

57
Q

anesthetic management T and A

A

premed oral or intranasal versed,
IH induction with sevo,
intubate-deep (sevo and propofol 1-2mg/kg) or with short acting NDNMB,
analgesia-MSO4 0.1mg/kg or fentanyl 1-2mcg/kg (OSA cut meds to 1/2 dose),
Steroid-dexamethasone 0.3-1mg/kg,
emergence-extubate when child fully awake,

58
Q

post-tonsillectomy occurence

A

bleeding after surgery requiring surgical intervention (packing or suturing),
early-incidence 0.2-2%, withing 24 hrs 99% within 6 hrs.
Delayed- 0.1-3% incidence, 24 hrs up to 2-3 wks, peak-day 7

59
Q

post-tonsillectomy bleeding risk

A 
older pts,
presence of inflammation, infection,
preop ingestion of ASA, NSAIDS-inhibit plt function,
coagulopathy,
pts that have had strep multiple times,
using nsaids post op
60
Q

disturbance of hemostasis

A

thrombocytopathies- nsaids, van willebrands, factor deficiencies, increased fibrinolysis

61
Q

prevention of post tonsillectomy bleeding

A 
careful dissection in tonsilar capsule,
meticulous hemostasis,
avoid surgery during/immediately after acute inflammation, infection,
avoid blind vigorous suctioning,
avoid use NSAIDS
62
Q

Sign of post op tonsil bleed

A

frequent swallowing and throw up blood

63
Q

tonsil bleed intubation RSI?

A

YES

64
Q

clinical presentation post tonsillectomy bleeding

A 
hypovolemia,
anemia,
agitation,
shock,
stomach full of blood,
active bleeding (poor visualization of glottis)
65
Q

Assessment of volume status

A

BP(orthostatic changes, HR, urine output, mucus membranes, skin turgor, sensorium),
Labs, H/H, urine specific gravity/osmolality

66
Q

When does establishing IV acess-rehydration or transfusion must begin? for tonsil bleed

A

Immediately

67
Q

anesthetic management for post tonsil bleed?

A

RSI,
2 suctions, 2 blades, multi-styletted cuffed ETTs, experienced assistant.
atro, prop, etomidate, ketamine, roc, succs.

68
Q

emergence post tonsil bleed

A

awake with suction stomach

69
Q

what is choanal atresia?

A

occlusion of one or both posterior nares

70
Q

atresia is partially or totally bony in ___% of cases

A

90

71
Q

choanal atresia has frequent association with

A

craniosynostosis

72
Q

neonates are obligatory nose breathers, bilateral choanal atresia causes suffocation if the mouth is not kept open

A

oral airway or large rubber nipple secured the mouth

73
Q

with choanal atresia what needs to happen within the first few days of life

A

surgical correction or tracheostomy

74
Q

anesthetic management choanal atresia

A

awake intubation with oral RAE tube,
maintenance -O2,N2O,IH NDNMB may be used, opioids for analgesia,
wide awake for extubation,

75
Q

post op choanal atresia

A

partial or intermittent airway obstruction may persist for some time, so the infant must be observed with appropriate monitoring until airway patency is assured.

76
Q

if stents are placed in choanal atresia

A

baby will transer to ICU

AA1 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions