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My Peds > Review > Flashcards

Review Flashcards

1
Q

What is the normal Hgb for a full term infant?

A

18-20 g/dL

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2
Q

The primary event of the respiratory system transition is ___________________________.

A

Initiation of ventilation

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3
Q

How much negative pressure must an infant generate to inflate the lungs?

A

—> -70cm H2O

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4
Q

What helps the infant maintain FRC/lung inflation during anesthesia?

A

PEEP of 5 cmH2O

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5
Q

The initial hyperpneic response is abolished by __________ and ________.

A

Hypothermia

Low levels of anesthetic gases

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6
Q

What does hypoxia cause in babies?

A

Profound bradycardia

** resuscitative efforts must occur when HR <60

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7
Q

T/F fetal circulation runs in parallel and PVR is high.

A

True

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8
Q

What is the treatment for persistent pulmonary hypertension?

A
  • adequate ventilation and oxygenation - 10mL/kg is an adequate tidal volume up to 10 years
  • avoid stress
  • minimal handling
  • hyperventilate
  • prostaglandin (alprostadil infusion)
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9
Q

Why is the neonate considered an obligate sodium loser?

A
  • tubules do not completely reabsorb Na under the stimulus of aldosterone
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10
Q

What is the lowest acceptable Hct in an infant and why?

A

35% is lowest Hct

  • increased blood volume per unit weight
  • increased CO per unit weight
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11
Q

How is heat production achieved in the neonate?

A

Non-shivering thermogenesis

—> metabolism of brown fat

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12
Q

Once a premie always a ______________.

A

Premie—> prone to laryngospasms

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13
Q

In an uncooperative induction, what is the order for application of monitoring equipment?

A

1st: pulse ox
2nd: ECG
3rd: BP cuff

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14
Q

If a pt is extubated deep and brought straight to the PACU, what are they at risk of?

A

Post-op laryngospasm while going through stage 2 in PACU

—> DO NOT STIMULATE THE CHILD UNTIL AWAKE!

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15
Q

Where is the pediatric larynx located and what are some characteristics in this area?

A

Larynx located at C3-4
Airway is funnel shaped
* narrowest portion is the cricoid cartilage *

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16
Q

How long is the trachea up to 1 year of age?

A

5-9 cm—> don’t bury the ETT!

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17
Q

What shape is the epiglottis in the infant?

A

Ω (omega) or U shaped

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18
Q

What is the FRC in an infant?

A

Small, 27-30mL/kg, but not functional

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19
Q

What are s/s of epiglottitis?

A
  • rapid clinical progression
  • high fever >39ËšC
  • dysphasia
  • drooling
  • dysphonia
  • strider
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20
Q

Treatment for epiglottitis?

A
  • urgent intubation in OR with ENT present
  • do nothing to agitate the child
  • maintain spontaneous ventilation
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21
Q

Where is the most common site for foreign body aspiration and what do you do if airway obstruction is present?

A
  • most frequent site is right mainstem

- inhalation of volatile agent in O2 maintaining spontaneous ventilation

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22
Q

When is the peak time for post tonsillectomy bleeding?

A

POD 7

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23
Q

Describe gastroschisis.

A
  • 1:15,000-30,000
  • isolated lesion
  • lateral defect
  • umbilical cord normal
  • bowel exposed, thickened, edematous
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24
Q

Describe omphalocele.

A
  • 1: 5,000-7,000
  • associated anomalies common
  • central defect
  • umbilical cord within defect
  • sac covers organs, bowel normal
25
Q

When is it unsafe to close the abdomen?

A
  • intragastric pressure >20mmHg
  • change in CVP >4mmHg above baseline
  • ETCO2 > 50mmHg
  • PIP > 35cmH2O
26
Q

What is pyloric stenosis and when does it occur?

A
  • stenosis of the pyloric sphincter causing forceful projectile nonbilious vomiting
    —> results in hyponatremia, hypokalemia metabolic alkalosis
  • occurs between 2-8 weeks of life
27
Q

Is pyloric stenosis a medical or a surgical emergency?

A

Medical emergency

  • treat electrolyte and fluid imbalances before surgical correction
    • aspiration of gastric fluid is primary concern
28
Q

What is the greatest concern with congenital hip dislocation?

A
  • LOSS OF AIRWAY during spica casting
29
Q

With osteogenesis imperfecta what must you keep in mind?

A
  • Succinylcholine induced fasiculations can cause fractures

- gentle manipulation of C spine and airway is vital

30
Q

With cerebral palsy what must be remembered if seizure disorders are present?

A

Anti seizure meds should be taken up to and including day of surgery

31
Q

What are different considerations with different degrees of scoliosis?

A
  • thoracic curvature > 25Ëš requires an echo
  • > 40 Ëš curvature requires surgical intervention
  • > 65–> restrictive lung disease
32
Q

During scoliosis repair what area key considerations?

A
  • prone procedure
  • high risk of bleeding
  • decreased CO
  • increased intra abdominal pressure
  • IVC compression
33
Q

How do you calculate and prepare the appropriately sized ETT?

A

(16 + age in years)/4
Always prepare calculated tube and 1/2 size smaller
* there should be an air leak around the tube at a pressure between 15-25 cm H2O

34
Q

How would you calculate succinylcholine doses for laryngospasm, both IV and IM?

A

IV: 0.4mg/kg
IM: 4mg/kg
* succinylcholine vial concentration = 20mg/mL

35
Q

What does stage 1 look like?

A 
Awake 
Eyes midline
Pulse irregular
BP normal 
resp. Irregular
36
Q

What does stage 2 look like?

A 
Hyper-excitable
Eyes divergent
Resp. Irregular
HR irregular and fast
BP high
37
Q

What does stage 3 look like?

A 
Asleep
Eyes midline 
Resp. Even 
Pulse steady and slow
BP normal
38
Q

What does stage 4 look like?

A 
Cardiovascular reflexes are anesthetized
Eyes midline 
Pulse weak and thready
BP low
Resp. Slow and shallow
39
Q

Why is IV induction advantageous?

A
  • asleep without going through stage 2

* ** risk of laryngospasm is very low

40
Q

What is the most common cause of bradycardia in a child?

A

Hypoxia

You should really know this

41
Q

How does congenital diaphragmatic hernia present clinically?

A

Herniation of abdominal organs into thoracic cavity

  • dyspnea
  • cyanosis
  • apparent dextrocardia
  • bulging chest
  • scaphoid abdomen
  • decreased breath sounds
  • distant heart sounds
  • bowel sounds in chest
42
Q

How is congenital diaphragmatic hernia treated?

A

Medical management for 24-48 hours prior to surgery
—> maximize arterial oxygenation- intubate, mechanical ventilation, correction of acidosis, improve pulmonary perfusion
- prevent hypothermia
- prevent pain

43
Q

What are some precautions that should be taken when caring for the CDH pt?

A
  • minimize barotrauma
  • do not bag mask ventilate—distends the stomach
  • hyperventilate (goal PaCO2 is 25-35)
  • fentanyl
  • minimal handling
  • do not use N2O!!
  • prevent hypothermia
44
Q

What is tracheoesophageal fistula and how does it present?

A

Esophageal Atresia with or without a fistula between the esophagus and trachea

  • inability to manage oral secretions
  • excessive salivation
  • choking on first feed
  • coughing
  • cyanosis
  • aspiration
  • gastric distention
  • PNA
    • diagnosed by inability to pass catheter or OGT into stomach, CXR
45
Q

T/F VACTERL is not associated with tracheoesophageal fistula.

A

False

It is one of the associated anomalies of VACTERL

46
Q

What are anesthetic considerations for TEF?

A
  • concern for aspiration
  • gastric distention
  • respiratory comprise on induction
  • in unstable infants consider awake intubation
  • on stable infants inhalation induction with spontaneous ventilation
  • avoid high PPV
  • maintain small tidal volume
  • AVOID N2O
  • position in lateral decubitus position for right thoracotomy
47
Q

What are intra-op and post op complications for TEF?

A 
intra-op: 
- airway compromise
- hypothermia
- hypoglycemia
- return to fetal circulation (R to L shunt)
Post-op:
- DO NOT extend head
- DO NOT suction beyond level of esophageal anastomosis
48
Q

What are NPO guideline for peds?

A

2 hours clears
4 hours breast milk
6 hours formula
8 hours solids

49
Q

What is unique about the pediatric larynx when compared to the adult?

A

Proportionately smaller

More anterior and cephalad

50
Q

What is the narrowest portion of the airway in a child?

A

Cricoid cartilage (below the vocal cords)

51
Q

What are the epiglottis and tongue in a child like compared to the adult?

A

Epiglottis is longer and narrower

Tongue is proportionately larger

52
Q

What area the head and neck like in a child compared to the adult?

A

Head and occipital are proportionately larger

Neck is much shorter

53
Q

Are the adenoids larger or smaller in a child?

A

Larger

54
Q

T/F risk of mainstem intubation is much higher in pediatric patients due to short trachea and bronchus?

A

True

55
Q

What are commonly seen characteristics in down’s syndrome?

A
  • smaller than normal for age
  • craniofacial: microbrachycephaly
  • short neck, low set ears
  • macroglossia, microdontia with fused teeth
  • mandibular hypoplasia
  • narrow nasopharyngeal with hypertrophic lymphatic tissue: T and A
  • generalized hypotonia
56
Q

What are common heart defects associated with down’s syndrome?

A
  • AVSD (most common)
  • VSD
  • TOF
  • PDA
57
Q

What are anesthetic considerations for the down’s syndrome pt?

A
  • strong underlying vagal tone —> BRADYCARDIA WITH GA INDUCTION HAPPENS VERY QUICKLY*****
  • OSA, MR, Pulm HTN, CHD with hypoxemia
  • atlantoaxial instability
  • subglottic stenosis
  • minimal head movement- smaller ETT
58
Q

What causes metabolism of brown fat?

A

Cold stress mediated by the SNS

59
Q

Cold stress in an infant causes what?

A

“Cold stress” cascade—> acidosis, hypoglycemia, right to left shunting

My Peds (6 decks)

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