PICU

Question 1

What are two abnormal physiological responses you may see in the few days post-op in pts with severe cerebral palsy? Thought to be due to the __________.

In what kind of surgery is this seen a lot?

Answer 1

Hypoventilation and hypotension.

Anesthetic.

Spine surgery.

Question 2

What are 4 ways to differentiate between SIADH and cerebral salt wasting syndrome in the pt with neurological disease?

Answer 2

• Urine Na is much higher in CSWS
• Serum osmolality is low in SIADH, normal in CSWS
• Pt is dehydrated in CSWS, euvolemic in SIADH
• Even with treatment with hypertonic saline, the Na is slow to rise in CSWS

Question 3

Your patient is comatose because he overdosed on hydromorphone contin. Instead of just letting it wear off, counteract the side effects with:

Answer 3

A naloxone infusion.

Question 4

What is the dose of hypertonic saline in a child

Answer 4

4 to 6 mL/kg

Question 5

Name 5 ways mannitol helps in TBI:

Answer 5

1. Rheology: draws fluid out of RBCs, making them smaller and more easily able to squeeze through tight spaces and perfuse the microcirculation.
2. Decreases cerebral edema: by drawing fluid out of swollen brain tissue through the BBB
3. When given as a fluid bonus, increases the cardiac output.
4. Osmotic diuretic
5. Anti-inflammatory

Question 6

Alternative to P/F ratio to determine whether pt is hypoxemic: Approximate expected PaO2 in a healthy pt at sea level, 15 degrees celcius, breathing FiO2 of: 0.21, 0.50, 100?

Answer 6

100
360 (# days in a year)
670

Question 7

What are some things you can do to improve outcome of patients with ARDS?

Answer 7

• Lung protective ventilation
• Prone position - in 75% of pts increases SpO2 but no improvement in mortality. But in severe ARDS, probably does improve outcome.
• Don’t fluid overload
• Several rescue things that haven’t been shown to improve mortality: Inhaled nitric oxide, HFO

Question 8

Is the pulmonary edema in ARDS protein-rich or protein-poor?

What are the two categories of ARDS and some examples of each?

Answer 8

Protein rich pulmonary edema
Direct - pneumonia, aspiration
Indirect - sepsis, multitrauma

Question 9

Three treatment things that are shown not to help in ARDS:

Answer 9

Bicarbonate
Surfactant
Steroids after 14 days (increases mortality) and no consensus before 14 days