PICU

Question 1

How is the pediatric different from adult airway?

Answer 1

Large tongue
Larynx anterior and superior
Cricoid is narrowest part
Floppy epiglottis
Large occiput

Question 2

How do you calculate the ETT size?

Answer 2

Uncuffed = age (yr)/4+4
Microcuffed = age(yr)/4+3.5

Question 3

What are some features of inhalation injury and what do you do about it?

Answer 3

Facial burns, singed eyebrows/eyelashes/nasal hairs, dyspnea, carbon deposits/erythema in mouth or throat, carbonaceous sputum
- INTUBATE (otherwise you might miss your chance)

Question 4

What is the dosing for epinephrine?

Answer 4

Epinephrine (1:10 000) 0.01mg/kg or 0.1mL/kg

Question 5

What are the side effects of midazolam/benzos?

Answer 5

Action: sedative, amnestic
SE: Respiratory depression, no analgesia, hypotension

Question 6

What are the side effects of ketamine?

Answer 6

Action: analgesia, dissociative amnestic, releases endogenous catecholamines, anticonvulsant and bronchodilator
SE: raised intraocular pressure, maybe ICP (not true but in old exam questions increased ICP may come up)

Question 7

What are the side effects of fentanyl/opioids?

Answer 7

Action: analgesic, weak sedative
SE: cardiovascular compromise, miosis, respiratory depression

Question 8

What do you see in propofol infusion syndrome?

Answer 8

• Cardiac failure, rhabdomyolysis, metabolic acidosis, and kidney failure, and is often fatal
• Green urine

Question 9

What is one scenario in which you need to CALL for help rather than intubate?

Answer 9

Mediastinal mass! This is because when you sedate the airway will collapse and you won’t be intubating.. need to call for help.

Question 10

How can you verify placement of an ETT?

Answer 10

Misting in the tube, yellow colour change on CO2 detector, direct visualization through cords, equal breath sounds, equal breath sounds, absence of breath sounds in epigastrium

Question 11

What is Systemic Inflammatory Response Syndrome (SIRS)?

Answer 11

The presence of at least two of the following four criteria, one of which must be abN temperature or leukocyte count:

• Core temp. >38.5 or <36C
• Tachycardia (>2SD above N for age)
• Tachypnea (>2SD above N for age)
• Leukocyte count elevated or depressed for age or >10% immature neutrophils
• Tachycardia and tachypnea are in the absence of secondary reason ex. drugs etc.

Question 12

What is the admission criteria for a burn patient?

Answer 12

• Second degree burns covering >10% of TBSA
• Third degree burns covering >2% of TBSA
• Significant burns involving hands, feet, face, joints or perineum
• Burns resulting from suspected abuse
• Electrical burns
• Explosion, inhalation or chemical
• Circumferential burns

Question 13

How do you calculate IVF for a burns patient?

Answer 13

Give “maintenance” as to 4-2-1 rule AND PF = 4mL x TBSA% x wt(kg).
- Give 1/2 of the PF over the first 8 hours, the rest over the next 16hours.
Use this for patients with >10% TBSA for burns that are NOT superficial.
Titrate fluids to U/O (0.5-1mL/kg/hr).

Question 14

What features are associated with a poor prognosis in pediatric drowning?

Answer 14

• Submersion time (longer than 5 minutes)
• Time to initial resuscitation (no attempts for more than 10 minutes)
• LOC (coma)
• Acidosis (pH=7.10) upon presentation to the ED

Question 15

Children with flame-related burns and/or burns sustained in a closed space are at risk for what 3 types of impact on oxygenation?

Answer 15

• Airway compromise
• Parenchymal lung injury
• CO or cyanide poisoning (in this case, the O2 sat may overestimate actual oxygenation)

Question 16

What CNs are responsible for the corneal reflex?

Answer 16

CN V & VII

Question 17

What CNs are responsible for the oculo-vestibular reflexes?

Answer 17

CN III, IV, VI, VIII

Question 18

What CNs are responsible for the gag reflex?

Answer 18

CN IX, X

Question 19

What CN is responsible for the cough reflex?

Answer 19

CN X