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Peds > Peds week 3 > Flashcards

Peds week 3 Flashcards

1
Q

For deoxygenated blood to exit the fetus, it passes through the __ arteries and then the __ arteries to the placenta

A

hypogastric arteries

umbilical arteries

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2
Q

for oxygenated blood to reach the fetus, after leaving the placenta it travels through the __ vein, which connects with the inferior vena cava via the ductus __ venosus

A

umbilical vein

ductus venosus

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3
Q

For the last time, during FETAL circulation, the PVR is __ and the SVR is __

A 
PVR high (b/c lungs are bypassed)
SVR low
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4
Q

What four defects define tetralogy of fallot? and what kind of shunt?

A 
pulmonary stenosis (leads to right to left shunt)
overriding aorta
RV hypertrophy (also right to left shunt)
ventricular septal defect
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5
Q

what is the most common CYANOTIC congenital heart disease?

A

cyanosis = a right to left shunt that bypasses lungs. The most common is Tetralogy of fallot

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6
Q

How to treat a “tet spell” aka acute worsening of tetralogy of fallot

A

100% fio2, hyperventilation (decreasing etco2 decreases PVR and encourages pumonary circulation, increase preload with IVF, sedate, increase SVR with phenylephrine to reverse shunt, beta blocker to slow HR

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7
Q

when repairing tetralogy of fallot, what side do you put the a-line on?

A

the opposite side of the clamped subclavian artery, most probably place it on the left side as the right subclavian will probably be clamped

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8
Q

what are teh anesthetic management goals for tetralogy of fallot?

A

maintain volume, increase SVR with phenylephrine to lessen shunt, decrease PVR to lessen shunt

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9
Q

an infant with tetralogy of fallot will have normal __ and __, but decreased __

A

normal pH and PaCO2, decreased PaO2

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10
Q

nitrous for a child with tetralogy of fallot?

A

NO, INCREASES PVR and worsens shunt

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11
Q

list three conditions that increase right to left shunt associated with tetralogy of fallot?

A

acidosis, hypercarbia, hypotension, volatile anesthetics, anything that causes histamine release

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12
Q

One more time, what four characteristics define tetralogy of fallot?

A

VSD, right ventricular outflow obstruction (pulmonary stenosis), RV hypertrophy, and overriding aorta

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13
Q

what is the most crucial part of successfully reversing the transposition of the great arteries?

A

connecting the coronary arteries to the neo-aortic root

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14
Q

what is truncus arteriosus?

A

a big VSD with one common valve for both ventricles, leads to constant mixing of oxygenated and deoxygenated blood.

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15
Q

what is a double outlet right ventricle?

A

both the PA and aorta arise from the right ventricle, often with a large VSD

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16
Q

what’s up with hypoplastic left heart syndrome?

A

very small LV due to mitral and/or aortic valve stenosis or atresia (closure), so blood flows from the Left atrium to the RA/RV via ASD, thus the RV is acting as a single ventricle, and systemic blood has to go from RV to PA and then to aorta via PDA for systemic circulation

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17
Q

what is a norwood stage 1?

A

creation of neo-aorta and placement of BT shunt for passive pulmonary blood flow

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18
Q

during norwood surgery, should PVR be increased or decreased?

A

NEITHER, they have to be just right. because if the PVR increased then cyanosis would result, and if PVR decreased then the lungs would flood and systemic circulation would be low
KEEP SPONTANEOUSLY BREATHING WITH FiO2 21% AND PROSTAGLANDIN INFUSION TO KEEP PDA OPEN

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19
Q

oxygen is a drug slide

A

I have no clue, you’ll have to read it yourself. Slides 69 and 70. Seems contradictory to last weeks info.

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20
Q

If you want to maintain a PDA

A

give prostaglandin

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21
Q

if you want to close a PDA

A

give indomethacin or PDA ligation

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22
Q

why must you AVOID the IJ vein for a norwood?

A

will use it in the future for a glenn shunt

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23
Q

norwood surgical considerations

A

high dose opioid, venous access via femoral or umbilical vein

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24
Q

what is a norwood stage 2? aka bi-directional glenn shunt

A

BT shunt is disconnected, SVC is removed from right atrium and attached to PA.

25
Q

With a bidirectional glenn, early extubation is desired because ___

A

positive intrathoracic pressures reduces flow in the Glenn shunt, also avoid PEEP and hyperventilation for the same reasons.

26
Q

Other considerations for the Glenn shunt

A

maintain venous return with increased preload, keep hct >30, and have external defibrillator pads on

27
Q

A fontan operation AKA norwood 3 is the __

A

connecting the IVC to PA with a conduit, and creation of a fenestration between the conduit and the right atrium.

28
Q

With the fontan, it is essential that the ___ remains LOW because the single RV is providing systemic circulation adn the pulmonary blood supply is by passive flow from the SVC and IVC

A

PVR MUST REMAIN LOW!!

29
Q

With the fontan, what is the purpose of the fenestration between IVC and RA?

A

If PVR rises, blood will be directed to the RA and maintain CO, albeit the child will be cyanosed, KEEP PVR LOW!

30
Q

Total anomalous pulmonary venous connection (TAPVC) is a __ to __ shunt

A

right to left, because the pulmonary veins drain into the right heart (via SVC, IVC, or RA) and then go left through an ASD

31
Q

Total anomalous is when all 4 pulmonary veins drain into an anomalous site, partial is when only some of them do and the rest drain into the __ like normal

A

LA

32
Q

supracardiac TAPVC drains into the __

A

SVC

33
Q

infracardiac TAPVC drains into the __

A

IVC

34
Q

cardiac TAPVC drains into the __

A

RA via coronary sinuses

35
Q

aortic stenosis is a LVOT obstruction

A

left ventricular outflow tract, requires urgent valvuloplasty

36
Q

important points for aortic stenosis

A

normal HR, maintain SVR to improve coronary perfusion, avoid HTN

37
Q

Who is highest risk of subacute bacterial endocarditis?

A
  1. repaired within last 6 months with prosthetic material
  2. unrepaired with palliative shunt/conduit
  3. transplant recipient with valve disease
  4. history of endocarditis
38
Q

highest risk SBE patients receive ABX prior to __

A

dental, respiratory tract, infected skin, subcutaneous, and musculoskeletal procedures

39
Q

SBE high risk DO NOT receive ABX for __

A

GI/GU procedures

40
Q

SBE prophylaxis dosing

A

50 mg/kg for all ABX except clinda is 20mg/kg

41
Q

decreased ETCO2 causes ___ PVR

A

decreased ETCO2 causes decreased PVR

42
Q

PVR is increased with __

A

hypoxemia, hypercapnia, PEEP, acidosis, hypothermia, atelectasis, stress/light anesthesia, and low fio2

43
Q

halothane drawbacks

A

significant hypotension, arrhythmias, and bradycardia

44
Q

nitrous for induction with sevo is __

A

OK

45
Q

ketamine dose

A

1-2 mg/kg

46
Q

how does etomidate kill?

A

adrenal suppression, inhibition of steroid synthesis after single dose

47
Q

who to avoid propofol in?

A

patients with fixed CO like severe aortic or mitral stenosis - causes severe hypotension

48
Q

prostaglandin E1 maintains the patency of __

A

ductus arteriosus

49
Q

what should you check when inhaling nitric

A

methemoglobin

50
Q

What is the half life of flolan?

A

6 minutes, DO NOT interrupt the infusion! nanograms/kg/min

51
Q

how does sildenafil work?

A

potentiates pulmonary vasodilating effects of nitric by increasing cGMP

52
Q

What does preductal and postductal coarctation of the aorta refer to ?

A

narrowing of the aorta either before or after the ductus arteriosus

53
Q

if an infant has preductal coarctation, where should you measure BP?

A

right arm, because the coarcation is on the aorta distal to the takeoff of the right subclavian

54
Q

Where would you measure postductal pulse ox?

A

left foot or left toe

55
Q

why measure preductal pulse on on the right finger?

A

better index of cerebral oxygenation than postductal on the left toe

56
Q

DO NOT sample ABGs from the __ or the __

A

brachial artery = nerve damage

femoral artery = femoral head necrosis

57
Q

your patient has a right to left shunt through a VSD. what should you do?

A

don’t make the shunt worse by increasing PVR or dropping SVR

58
Q

would a right to left shunt hasten or slow inhalational induction?

A

slow, because less blood is passing the lungs

59
Q

would a right to left shunt hasten or slow IV induction?

A

hasten, opposite of inhalational

Peds (8 decks)

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