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Principles II- Josh > Random Peds info > Flashcards

Random Peds info Flashcards

random shit

1
Q 
Ages for all pediatric age groups
newborn
infant
toddler
preschooler
school age
adolescent
A 
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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2
Q

What facilitates the newborns first breath

A

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

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3
Q

Foramen Ovale closes when and r/t what

A

2-3 months

r/t decreased RAP, Inc SVR thus Inc LAP

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4
Q

Ductus Arteriosus closes when (3 stages)

A

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

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5
Q

Ductus Venosus closes when

A

1-3 hours

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6
Q

why are kids hard to mask ventilate

A

large tongue
Obligate nasal breathers
Narrow nasal airways

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7
Q

Why are kids hard to intubate

A 
Kare U shaped epiglottis (stiff)
small submental space
Large tongue
Large occiput
Short neck
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8
Q

Why are uncuffed tubes used to intubate peds

A

to facilitate an increased internal diameter

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9
Q

You should hear a leak at what with uncuffed tubes

A

20-25 cmH20

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10
Q

Why do peds chest move less than adults during ventilation

A

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

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11
Q

Respiratory physiology of newborns

A 
Increased O2 consumption
Increased Metabolic rate
Increased Alveolar ventilation
Increased Ventilatory rate
Decreased FRC
Increased closing capacity
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12
Q

Neonates CO is MOSTLY dependent on what? and why?

A

HR

b/c they have fixed stroke volume

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13
Q

Why can the fetus maintain a lower PaO2

A

HbF has higher affinity for O2

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14
Q

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

A

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

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15
Q

mylenation is not complete until what age

A

3 YO

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16
Q

the spinal cord ends where in peds

A

L3

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17
Q

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

A

40-50%

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18
Q

Why is it difficult for neonates/ newborns to regulate temp

A

immature ANS
Thin skin
decreased fat
increased BSA to weight ratio

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19
Q

how can you est peds weight

A

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

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20
Q

peds have a higher water concentration 75%. this creates a much larger Vd what does this mean

A

need more drug for same effect ( meds will diffuse throughout a greater volume and have less effect)

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21
Q 
Oral route
form
pros
ionization (importance)
metabolism
for what age groups
A

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

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22
Q

Rectal

3 pathways

A

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

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23
Q

IM
2 locations?
why not use dorsal gluteal?
total volume for ages?

A
  • 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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24
Q

IV

cons?

A

difficult to access

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25
Q

with induction doses there is a decreae in what 4 things???? but regarless the large Vd requires higher doses

A

protein binding
increased blood flow to VRG
decreased muscle/fat tiissues
faster redistribution to non VRG

26
Q

Doses compared to adult

Prop and Ketamine

A

Prop ped 2-3 adult 1.5-2.5

ketamine ped 1-2 adult 1

27
Q

What type of infusions should never be continued into the ICU for sedative purposes

A

Propofol

28
Q

with NMBD and kids you will give larger doses due to larger Vd but this also means what

A

longer duration do to immature organs

29
Q

Why not use suxs with kids

A

more sensitive to adverse effects

HyperK, dysrhythmias, rhabdo/ masseter spasms/ MH

30
Q

If a ped has cardiac arrest after induction with suxs how do you treat

A

as if they became acutely hyperK+

31
Q

What type of fluid should be used in neonates and newborns and why?

A

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

32
Q

Main components of the ped prop eval? 6 steps

A
  • 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
33
Q

Do not use the term “________” when discussing anesthesia. try using what words instead

A

“put to sleep”

—-go to sleep

34
Q

how should you conduct the interview body position

A

sitting or kneeling (unintimidating)

35
Q

Significant PMH begins in the ________ period

A

perinatal

36
Q

for PMH with perinatal hx what should you ask

A

how was the pregnancy?
Any complications?
any time in PICU?
any surgeries fist few months

37
Q

it is very important to investigate allergies, not only meds but _____________ as well

A

enviromental

38
Q

what can you ask about to determine latex allergies in peds

A

any reactions to blowing up balloons or playing with rubber toys

39
Q

what d/o has a high incidence of latex allergy?

A

spina-bifida

40
Q

“perhaps the most crucial part of the preop evaluation is that which allows what”

A

time for the parents to ask questions

41
Q

what are some airway questions to ask

A

hx snoring
apnea episodes
mouth breathing
chronic nasal stuffiness

42
Q

Signs of an innocent murmur

A 
occur early systole 
short in duration
low intensity
crescendo-decrescendo
poorly transmitted
43
Q

Signs of an pathological murmurs

A 
occur late in systole
pansystolic
very loud
continuous
all diastolic
44
Q

Pts with any type of pathological murmur will require what

A

bacterial prophyylaxis agains subacute bacterial endocarditis

45
Q

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?

A

nope

only cancel if symptoms are worse than normal

46
Q

as a rule what are contraindications to proceeding with any planned elective surgery: 4 things

A

temp > 38
productive cough yellow/green mucus
purulent nasal d/c
\any signs of lower lung involvement (wheezing/ rhonchi)

47
Q

what is an exception to the last card

A

elective ENT (fixes these problems)

48
Q

If there is a cancellation you need to wait how long to reschedule

A

4-6 weeks ( and send to pediatric md for rx)

49
Q

A preop HGb should be done when?

A

suspected anemia

< 1 y/o with chronic illness

50
Q

elective sx should be delayed until preop Hct is what in premature or previously premature infants

A

> 30%

51
Q

if the head goes forward (down) what happens to the tube? and if the head goes back (up) what happens to the tube

A
  • deeper

- comes out

52
Q

s/s of TEF
immediate
delayed

A 
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
53
Q

TEF is often associated with what other abnormalities?

A 
VACTERl
Vertebral abnormalities
Anus
Congenital heart defects
tracheo-
espophageal fistula
radial aplasia
renal abnormalities
limb abnormalities
54
Q

what to remember about TEF during induction

A
  • minimize positive pressure ventilation prior to OETT placement (don’t mask)
  • R mainstem pt ( then pull back slightly)
55
Q

Main s/s for malrotation and Midgut volvulus

A

BILIOUS VOMITUS (others or not)

56
Q

Congenital diaphragmatic hernia can go through what 3 foramen?
what is most common and what does it cause?

A
  • foramen of Morgagni (anterior)
  • Foramen of Bochdalek (posterior lateral) right and left
  • left is most common 90% stops growth of left lung
57
Q

how do you want to position pts with cingenital diaphramatic hernia until sx starts

A

bad side down

58
Q

trisomy 21 S/S 3 bad ones for irway

A

irregular dentation
short neck
protruding tongue

59
Q

Common problem with trisomy 21 r/t neck

A

weak atlano-axial joint

60
Q

If peak expiratory flow rate is less than ___% of predicted value should be reschedules

A

50%

61
Q

what should you set inhalation agents at for inhalation induction

A

N20 70% O2 30% sevo 8%

once asleep 100% O2 with sevo

Principles II- Josh (17 decks)

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