Random Peds info Flashcards by Josh Newby

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

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What facilitates the newborns first breath

Hypoxia
acidosis
sensory stimulation
(cord clamping, pain, touch, noise)

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Foramen Ovale closes when and r/t what

2-3 months

r/t decreased RAP, Inc SVR thus Inc LAP

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Ductus Arteriosus closes when (3 stages)

1) 2-3 hours muscles constrict
2) 1-8 days thrombus
3) 1-4 months complete anatomic

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Ductus Venosus closes when

1-3 hours

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why are kids hard to mask ventilate

large tongue
Obligate nasal breathers
Narrow nasal airways

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Why are kids hard to intubate

Kare U shaped epiglottis (stiff)
small submental space
Large tongue
Large occiput
Short neck

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Why are uncuffed tubes used to intubate peds

to facilitate an increased internal diameter

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You should hear a leak at what with uncuffed tubes

20-25 cmH20

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Why do peds chest move less than adults during ventilation

ribs horizontal coming off vertebrae (opposed to the downward displacement of adults)

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Respiratory physiology of newborns

Increased O2 consumption
Increased Metabolic rate
Increased Alveolar ventilation
Increased Ventilatory rate
Decreased FRC
Increased closing capacity

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Neonates CO is MOSTLY dependent on what? and why?

b/c they have fixed stroke volume

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Why can the fetus maintain a lower PaO2

HbF has higher affinity for O2

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Why is there a physiologic anemia between ages 2-3 months

reduction of the HgF r.t breakdown and metabolism (Hgb life span ends)

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mylenation is not complete until what age

3 YO

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the spinal cord ends where in peds

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GERD is seen in approx what % of all newborns the 1st week of life?

40-50%

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Why is it difficult for neonates/ newborns to regulate temp

immature ANS
Thin skin
decreased fat
increased BSA to weight ratio

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how can you est peds weight

(age x 2) +9 = kg in 50th %

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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)

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Oral route
form
pros
ionization (importance)
metabolism
for what age groups

-ease of use
-liquid
-acid > stomach
Basic >intestines
-1st pass
-toddlers and children

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Rectal

3 pathways

-Superior
empties into portal system (1st pass)
-Middle/Inferior
empties into systemic circulation

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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

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cons?

difficult to access

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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

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