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Peds > Peds week 4 > Flashcards

Peds week 4 Flashcards

1
Q

All neonates plus infants who are small for gestational age have a __ skin‐surface area compared to body mass ratio and __ thermal conductance d/t thin layer of subcutaneous fat

A

large

increased

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2
Q

__ is greater in infants as a result of reduced keratin content in the infant’s skin.

A

evaporative heat loss

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3
Q

because infants have reduced ability to generate heat, they are more prone to __

A

hypothermia

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4
Q

Protective mechanisms such as vasoconstriction of peripheral vessels
slows heat loss from our bodies but ___

A

This thermoregulatory mechanism is
disrupted under anesthesia, specifically
since volatile and regional anesthetics
cause vasodilation and therefore greater
blood flow to the surface of our bodies

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5
Q

The initial, rapid decrease in core temperature DURING THE FIRST HOUR OF general anesthesia is due to __

A

core-to-peripheral redistribution of heat

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6
Q

__ and __ contribute to the most perioperative heat loss

A

radiation and convection

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7
Q

Radiation is the transfer of energy between 2 objects that are ___

A

not in direct contact, and have different temperatures

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8
Q

Excluding the first hour, __ is the most significant mechanism of heat loss

A

radiation

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9
Q

Our __ lose the greatest amount of heat due

A

heads

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10
Q

How to prevent radiation heat loss?

A

Increase the room temp and cover the head

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11
Q

__ is the process of creating air currents by heat

A

Convection

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12
Q

What percent of heat loss is due to radiation and convection?

A 
radiation = 40%
convection = 30%
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13
Q 
Patients who are sweating 
as well as patients who have 
areas of their bodies 
surgically prepped with 
liquids (e.g., isopropyl 
alcohol, povidone‐iodine, 
and chlorhexidine 
gluconate) experience heat 
loss by
A

evaporation

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14
Q

Which route does a BURN patient lose the greatest amount of heat?

A

Evaporation

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15
Q

__ is the transfer of heat by physically
touching a less warm object. Where two
objects are in direct contact, heat exchange
occurs from high concentration to lower
concentration

A

Conduction

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16
Q

Infants rely primarily on __ to generate heat.

A

non‐shivering thermogenesis

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17
Q

rown adipose tissue is located

in __

A

scapulae, axillae, mediastinum,
and around kidneys/adrenal
glands

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18
Q

Brown fat is highly vascularized and richly innervated
with sympathetic nerve fibers. The brown color is
caused by the abundance of __ which are
able to uncouple oxidative phosphorylation,
resulting in heat production

A

mitochondria

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19
Q

Nonshivering thermogenesis is possible within hours
after birth and may persist up to the age of 2 years.
However, nonshivering thermogenesis is reduced in
infants anesthetized with __

A

inhalational agents,

propofol or fentanyl

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20
Q

During anesthesia the normal thermoregulatory response of
the infant to cold stress is lost. Normal thermoregulatory skin
vasoconstriction is inhibited. There is also a redistribution of
body heat away from the central core to the periphery.

A

old stress and hypothermia also affects recovery from
anesthetic and relaxant drugs, impairs coagulation, may
depress ventilation, may result in dysrhythmias, and increases
post‐op O2
consumption

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21
Q

What controls non-shivering thermogenesis in infants?

A

autonomic nervous system

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22
Q

Premature infants may require ambient temp of __ to maintain normothermia

A

26 Celsius = 79 Fahrenheit

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23
Q

What is a pyrexial reaction?

A

manipulation of an infected organ or blood transfusion reaction

24
Q

Posterior
fontanelle
closes at age
__ months

A

4

25
Q

Anterior
fontanelle
closes at age
__ to __ months

A

9-18

26
Q

What is the pathogenesis of retinopathy of prematurity

A

variations in arterial oxygenation and exposure to bright light = use the lowest inspired
oxygen concentration that provides oxygen
saturations between 92% and 96% and strive to
avoid significant fluctuations in oxygen saturations.

27
Q

to avoid retinopathy of prematurity, avoid fio2 greater than

A

40%

28
Q

if your patient is light and their eyeballs are rolled up, that is called

A

bell’s phenomenon

29
Q

child with symptoms of uncomplicated URI who
is afebrile with clear secretions and who is otherwise
healthy,

A

proceed

30
Q

postpone elective surgery for more severe symptoms such as

A

mucopurulent
secretions, productive cough, pyrexia >38°C
(>100.4°F), or pulmonary involvement.

31
Q

consider bronchospasm if__

A

prolonged expiration,
increased airway pressure, slow upslope of ETCO
2 tracing, raised ETCO
2, and hypoxemia

32
Q

how to treat bronchospasm

A

deepen
anesthesia/analgesia, increase FiO2, increase
expiratory time (1:2.5), repeat ß2 agonist, if severe
(small doses of Epi 10‐20mcg iv or via ETT

33
Q

cystic fibrosis is caused by

A

Disruption of electrolyte transport in epithelial cells

34
Q

You have a CF patient. Although you should adequately reverse the patient, avoid excessive __ due to thickening of secretions

A

glyco

35
Q

How many breaths per minute on the ventilator for the neonate?

A

30-50

36
Q

In the neonate, chest wall compliance is __ but lung compliance is __ compared to an adult

A

chest wall is more compliant

lung is less compliant

37
Q

Why is subglottic stenosis such a big deal for peds?

A

even a small amount of swelling can occlude the airway

38
Q

How many alveoli in the neonate?

A

30 million (1/10 of an adult)

39
Q

How to calculate deadspace in a child?

A

2-2.5 ml/kg

kind of like the propofol dose

40
Q

what is a good tidal volume for a neonate?

A

7 ml/kg

41
Q

what is appropriate minute ventilation for a neonate?

A

250 ml/kg/min

42
Q

what is the length of infant trachea from cords to carina?

A

5-9 cm

43
Q

at what age do pediatric laryngeal cartilages reach adult proportions?

A

10-12 years

44
Q

What PaO2 is a good goal when ventilating a premature neonate?

A

60-80 mmHg

45
Q

At what rate do infants consume oxygen?

A

7ml/kg/min (similar to tidal volume)

twice that of an adult

46
Q

How to determine ETT in French?

A

age + 18

47
Q

How slow to run vanc and gent?

A

vanc 1 hour

gent 1/2 hour

48
Q

Children have __ protein binding but __ volume of distribution

A

lower binding

larger Vd

49
Q

__ soluble drugs will have a larger Vd, but __ soluble drugs will have a smaller Vd

A

water soluble = larger

lipid soluble = smaller

50
Q

volatiles in peds are quick on/ quick off due to

A

high alveolar ventilation in relation to FRC, more vessel-rich tissue, and lower blood-gas partition coefficients

51
Q

blend air with oxygen to maintain a sat of ___

A

90-95%

52
Q

HCG test for any female of childbearing age or

A

12 years +

53
Q

halothane is great except for arrhythmias, reduces CO and HR, and sensitizes the myocardium

A

limit epi to 1.5mcg/kg

54
Q

Iso is not appropriate for inhalation induction and can release __ into the breathing circuit when used with desiccated soda lime or baralyme

A

CO carbon monoxide

55
Q

How to reset emergence delirium?

A

small dose of propofol, adequate narcotics during case

56
Q

Infants require __ succs than adults

A

more

57
Q

when to use succs

A

emergency intubation, when seconds count, give atropine beforehand

Peds (8 decks)

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