Respiratory

Question 1

Carina: bifurcation point of the trachea into right and left primary bronchus

Answer 1

Important marker in ETT placement: proper distal ETT positioning is 2-3 cm proximal to the carina.

Anatomic landmark is the angle of Louis: angle formed at the junction of the manubrium and body of the sternum.

Question 2

Common site of pulmonary aspiration

Answer 2

Right lung because the right primary bronchus is wider and has a straighter angle than the left bronchus

Question 3

Oxyhemoglobin Dissociation Curve

Answer 3

Relatively unchanged hemoglobin affinity at PaO2 levels greater than 70 mm Hg
Small decreases in PaO2 result in a lessening affinity of oxygen for the hemoglobin molecule

Factors that promote release of oxygen from hemoglobin (shifts curve to the right) meaning more oxygen available to the tissues: acidosis, hypercapnia, hyperthermia, increased levels of 2,3-DPG

Factors that decrease the release of oxygen from hemoglobin (shift to left), meaning less oxygen available to the tissues: alkalosis, hypocapnia, hypothermia, decreased levels of 2,3-DPG

Question 4

Lateral decubitus position

Answer 4

Positioning for thoracotomy or thoracoscopy
Pooling of blood can cause decreased cardiac venous return and decreased cardiac output
Hyperabduction of the upside arm intraop has resulted in brachial plexus injury, permanent paralysis, and peripheral gangrene of the arm

Question 5

Medication for Rapid Sequence Intubation

Answer 5

Succinylcholine 2 mg/kg IV

Question 6

Post-extubation Laryngeal Edema

Answer 6

Avoid ETT in children with upper respiratory tract infection when possible
Ensure audible leak around cuff-less ETT at 25 to 35 cm H2O peak airway pressure
Prevent coughing or bucking on the ETT
Provide cool humidity in conjunction with supplemental oxygen therapy or room humidifier to soothe the inflamed laryngeal mucosa and thus minimizing coughing
Administer aerosolized racemic epinephrine (topical vasoconstrictor): 0.05 ml/kg (0.5 ml) of 2.25% solution in 3 ml of normal saline. May repeat in 30 minutes (max 3 times) and every 2 to 4 hours as needed
Dexamethasone 0.5 mg/kg IV every 6 hours as needed for moderate symptoms. Max dose in children is 10 mg.
If severe symptoms persist: positive pressure ventilation with a bag valve mask and supplemental oxygen, consider reintubation with smaller ETT