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Pediatrics > Resp Anatomy/Physiology > Flashcards

Resp Anatomy/Physiology Flashcards

1
Q

Where is the pediatric larynx located?

A

C3-4 (adult is C4-5)

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2
Q

What age should shoulder roll be used for intubation?

A

Definitely <6months, 6m-1yr optional use

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3
Q

What is the shape of the infant’s/ped’s epiglottis?

A

Omega shaped

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4
Q

T/F: Nares account for 80% of airway resistance in the infant?

A

False; only 25% (compared to 60% in adults)

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5
Q

What three things account for <6month old diaphragmatic breathing?

A
  1. Intercostal muscle contribute 20-40% of ventilation
  2. Thorax is weak and unstable
  3. Diaphragm contains smaller percentage of Type 1 muscle fibers
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6
Q

Why is pre-oxygenation so important for peds?

A

FRC is small and not very functional

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7
Q

What should be done/changed to combat the reduced FRC, peripheral airway collapse, impaired intercostal and diaphragm activity?

A

Add PEEP

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8
Q

Rough ETT for newborn?, 1-6months?, 6m-1yr?

A

Newborn 3mm.
1-6m 3.5mm.
6m-1yr 3.5-4

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9
Q

There should be an audible air leak around the cuff of the ETT at what pressure?

A

15-25 cm H2O

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10
Q

Stimulation of what nerve causes laryngospasm?

A

Superior laryngeal nerve

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11
Q

What causes laryngospasm in peds?

A
  1. Inhalation of volatile agents
  2. Excessive secretions in airway
  3. Presence of URI
  4. Manipulation of the airway
  5. *Stimulation of visceral nerve endings in pelvis/abd/thorax
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12
Q

What is first response to laryngospasm with LMA in place?

A

Remove LMA

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13
Q

What age has highest prevalence of post intubation laryngeal edema?

A

Ages 1-4

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14
Q

What is treatment of post intubation laryngeal edema?

A
  1. Humidification of inspired gases
  2. Racemic epi 0.5ml of 2.25% in 2-3ml NS
  3. Reintubation
  4. Tracheostomy
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15
Q

What would be leading differential diagnosis in 3-6yr old patient with upper airway obstruction?

A

Epiglotitis

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16
Q

What is etiology of epiglotitis?

A

Haemophilus influenzae Type B

17
Q

What are S/S of epiglotitis?

A
  1. Rapid clinical progression of symptoms
  2. Dysphagia
  3. Drooling
  4. Inspiratory stridor
  5. Resp distress
  6. High fever (>39C)
18
Q

What is treatment of epiglotitis?

A

O2, ABX, Urgent intubation of GA in OR, Antipyretics, fluids

19
Q

What is anesthetic management of child in ED with epiglotitis?

A
  1. Transfer to OR
  2. Sevo mask induction with child sitting/CPAP applied
  3. IV Access, Atropine
  4. ENT HAS TO BE PRESENT
20
Q

What equipment must be available for epiglotitis induction?

A
  1. Rigid ventilating bronchoscope

2. Surgical airway equipment

21
Q

What age group is closely associated with laryngotracheobronchitis?

A

<2 years

22
Q

What is etiology of laryngotracheobronchitis (croup)?

A

Paraflu Type 1, Flu A, and RSV

23
Q

T/F: Croup is associated with fast/abrupt onset of symptoms?

A

False; slow progression with Hx URI progressing to hoarse cry or barking cough

24
Q

Treatment for laryngotrachealbronchitis?

A
  1. Humidifed O2
  2. Racemic Epi
  3. Steroids
  4. Antipyretics
  5. Intubation rare
25
Q

What is most frequent site of foreign body aspiration?

A

Right mainstem

26
Q

Anesthetic management of foreign body aspiration?

A
  1. Inhaled induction with airway obstruction.
  2. IV induction without airway obstruction.
  3. RSI
  4. Topical Lidocaine 1% 1-2mg/kg
27
Q

T/F: Positive pressure must be used for foreign body aspiration?

A

False; PPV may cause foreign body to become trapped further

28
Q

What is the most common pediatric surgery we perform?

A

Tonsilectomy and adenoidectomy

29
Q

What is intraop steroid dose prior to extubation for T/A patient?

A

Decadron 0.5mg/kg up to 20 mg

30
Q

What time frame is considered “early” post-tonsillectomy bleeding?

A

Within 24% (most occurs within 6 hrs)

31
Q

What is the peak onset of delayed post-tonsillectomy bleeding?

A

Day 7

32
Q

What 4 things place a patient at higher risk of post-tonsillectomy bleeding?

A
  1. Older patient
  2. Presence of inflammation/infection.
  3. Preop ASA/NSAIDs
  4. Coagulopathy
33
Q

Clinical presentation of delayed post-tonsillectomy bleeding?

A
  1. Hypovolemia
  2. Anemia
  3. Agitation
  4. Shock
  5. Full stomach (blood)
  6. Active bleeding (poor glottis visualization)
34
Q

Anesthetic management of post-tonsillectomy bleeding?

A
  1. RSI with cricoid pressure
  2. 2 SXNs, 2 Blades/handles, experienced assistant
  3. Emergence= suction stomach, awake extubation
35
Q

Choanal atresia is frequently associated with what other diagnosis?

A

Craniosynostosis (small cranium)

36
Q

How is unilateral atresia typically diagnosed?

A

Presence of intractable unilateral nasal drainage

Pediatrics (5 decks)

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