Random Peds info Flashcards
random shit
Ages for all pediatric age groups newborn infant toddler preschooler school age adolescent
newborn- 0-1 MOA infant- 1-12 MOA toddler-1-3 YOA preschooler- 4-6 YOA school age- 6-13 YOA adolescent- 13-18
What facilitates the newborns first breath
Hypoxia
acidosis
sensory stimulation
(cord clamping, pain, touch, noise)
Foramen Ovale closes when and r/t what
2-3 months
r/t decreased RAP, Inc SVR thus Inc LAP
Ductus Arteriosus closes when (3 stages)
1) 2-3 hours muscles constrict
2) 1-8 days thrombus
3) 1-4 months complete anatomic
Ductus Venosus closes when
1-3 hours
why are kids hard to mask ventilate
large tongue
Obligate nasal breathers
Narrow nasal airways
Why are kids hard to intubate
Kare U shaped epiglottis (stiff) small submental space Large tongue Large occiput Short neck
Why are uncuffed tubes used to intubate peds
to facilitate an increased internal diameter
You should hear a leak at what with uncuffed tubes
20-25 cmH20
Why do peds chest move less than adults during ventilation
ribs horizontal coming off vertebrae (opposed to the downward displacement of adults)
Respiratory physiology of newborns
Increased O2 consumption Increased Metabolic rate Increased Alveolar ventilation Increased Ventilatory rate Decreased FRC Increased closing capacity
Neonates CO is MOSTLY dependent on what? and why?
HR
b/c they have fixed stroke volume
Why can the fetus maintain a lower PaO2
HbF has higher affinity for O2
Why is there a physiologic anemia between ages 2-3 months
reduction of the HgF r.t breakdown and metabolism (Hgb life span ends)
mylenation is not complete until what age
3 YO
the spinal cord ends where in peds
L3
GERD is seen in approx what % of all newborns the 1st week of life?
40-50%
Why is it difficult for neonates/ newborns to regulate temp
immature ANS
Thin skin
decreased fat
increased BSA to weight ratio
how can you est peds weight
(age x 2) +9 = kg in 50th %
peds have a higher water concentration 75%. this creates a much larger Vd what does this mean
need more drug for same effect ( meds will diffuse throughout a greater volume and have less effect)
Oral route form pros ionization (importance) metabolism for what age groups
-ease of use
-liquid
-acid > stomach
Basic >intestines
-1st pass
-toddlers and children
Rectal
3 pathways
-Superior
empties into portal system (1st pass)
-Middle/Inferior
empties into systemic circulation
IM
2 locations?
why not use dorsal gluteal?
total volume for ages?
- Vastus lateralis (small) Deltoid (older)
-nerve injury or vascular injury
-small Infant- 0.5 ml
Older infant 1 ml
school age 2mL
adolescent 3 ml
IV
cons?
difficult to access
with induction doses there is a decreae in what 4 things???? but regarless the large Vd requires higher doses
protein binding
increased blood flow to VRG
decreased muscle/fat tiissues
faster redistribution to non VRG
Doses compared to adult
Prop and Ketamine
Prop ped 2-3 adult 1.5-2.5
ketamine ped 1-2 adult 1
What type of infusions should never be continued into the ICU for sedative purposes
Propofol
with NMBD and kids you will give larger doses due to larger Vd but this also means what
longer duration do to immature organs
Why not use suxs with kids
more sensitive to adverse effects
HyperK, dysrhythmias, rhabdo/ masseter spasms/ MH
If a ped has cardiac arrest after induction with suxs how do you treat
as if they became acutely hyperK+
What type of fluid should be used in neonates and newborns and why?
Glucose containing solutions
D5 1/2 NS with 20 meq K+
D5 1/4 NS for premies (b/c inability to handle Na+)
-b/c newborns and neonates do not have sufficient glycogen supply
Main components of the ped prop eval? 6 steps
- meeting the family and pt and putting them at ease
- eliciting important information
- child and parent concerns
- system evaluation
- pertinent lab evaluations
- form anesthetic plan
Do not use the term “________” when discussing anesthesia. try using what words instead
“put to sleep”
—-go to sleep
how should you conduct the interview body position
sitting or kneeling (unintimidating)
Significant PMH begins in the ________ period
perinatal
for PMH with perinatal hx what should you ask
how was the pregnancy?
Any complications?
any time in PICU?
any surgeries fist few months
it is very important to investigate allergies, not only meds but _____________ as well
enviromental
what can you ask about to determine latex allergies in peds
any reactions to blowing up balloons or playing with rubber toys
what d/o has a high incidence of latex allergy?
spina-bifida
“perhaps the most crucial part of the preop evaluation is that which allows what”
time for the parents to ask questions
what are some airway questions to ask
hx snoring
apnea episodes
mouth breathing
chronic nasal stuffiness
Signs of an innocent murmur
occur early systole short in duration low intensity crescendo-decrescendo poorly transmitted
Signs of an pathological murmurs
occur late in systole pansystolic very loud continuous all diastolic
Pts with any type of pathological murmur will require what
bacterial prophyylaxis agains subacute bacterial endocarditis
if the child has a simple runny nose with clear to whitish discharge, temp < 38, no cough and clear lungs, and “is like this all the time” do you cancel the surgery?
nope
only cancel if symptoms are worse than normal
as a rule what are contraindications to proceeding with any planned elective surgery: 4 things
temp > 38
productive cough yellow/green mucus
purulent nasal d/c
\any signs of lower lung involvement (wheezing/ rhonchi)
what is an exception to the last card
elective ENT (fixes these problems)
If there is a cancellation you need to wait how long to reschedule
4-6 weeks ( and send to pediatric md for rx)
A preop HGb should be done when?
suspected anemia
< 1 y/o with chronic illness
elective sx should be delayed until preop Hct is what in premature or previously premature infants
> 30%
if the head goes forward (down) what happens to the tube? and if the head goes back (up) what happens to the tube
- deeper
- comes out
s/s of TEF
immediate
delayed
immediate excessive oral secretions regurditation of first feeding respiratory distress after several feedings inability to pass rigid OGT insulfattion of stomach Delayed recurring PNE inability to pass OGT
TEF is often associated with what other abnormalities?
VACTERl Vertebral abnormalities Anus Congenital heart defects tracheo- espophageal fistula radial aplasia renal abnormalities limb abnormalities
what to remember about TEF during induction
- minimize positive pressure ventilation prior to OETT placement (don’t mask)
- R mainstem pt ( then pull back slightly)
Main s/s for malrotation and Midgut volvulus
BILIOUS VOMITUS (others or not)
Congenital diaphragmatic hernia can go through what 3 foramen?
what is most common and what does it cause?
- foramen of Morgagni (anterior)
- Foramen of Bochdalek (posterior lateral) right and left
- left is most common 90% stops growth of left lung
how do you want to position pts with cingenital diaphramatic hernia until sx starts
bad side down
trisomy 21 S/S 3 bad ones for irway
irregular dentation
short neck
protruding tongue
Common problem with trisomy 21 r/t neck
weak atlano-axial joint
If peak expiratory flow rate is less than ___% of predicted value should be reschedules
50%
what should you set inhalation agents at for inhalation induction
N20 70% O2 30% sevo 8%
once asleep 100% O2 with sevo
