Test 1 Flashcards
1kg = _____g
1kg = 1000g
1g = ______ mg =______mcg
1g = 1000mg = 1,000,000mcg
PO Midazolam
0.5-0.7 mg/kg
MAX 20 mg
Propofol IV
2-4 mg/kg
Succinylcholine
1.5-2 mg/kg
Atropine
IV
IM
IV 10-20mcg/kg (min 0.1mg)
IM 20-40 mcg/kg
Cefazolin
30mg/kg
Vecuronium
0.1mg/kg
Fentanyl
1-2 mcg/kg
Hydromorphone
10-20 mcg/kg
Morphine
0.1 mg/kg
Suggamadex
2-4 mg/kg
Glycopyrrolate
10 mcg/kg
Neostigmine
0.07 mg/kg
MAX 5 mg
Ondansetron
0.1 mg/kg
MAX 4 mg
Ketorolac
0.5 mg/kg
MAX 30 mg
Infants weighing less than 2500gm at birth known as
Prematurity
Infant born before 37 weeks
Preterm
Infant born between 37 and 42 weeks
Term infant
Infant born after 42 weeks
Post-term
5 ways premature infant different from full term neonate
Less able to:
- suck
- maintain body temp
- swallow
- eat
- sustain ventilation
Definition of neonate
<30 days
Definition of infant
1-12 months
Definition of child
1-12 years
Definition of adolescent
13-19 years
Low birth weight
Less than 2.5 kg
Extremely low birth weight
Less than 1 kg
Very low birth weight
Less than 1.5 kg
Micro-preemie
Less than 750 gm
Deviation in relationship between duration of gestation and weight of infant may be associated with
- inadequate maternal nutrition
- significant maternal disease
- maternal toxins
- fetal infections
- genetic abnormalities
- fetal congenital malformations
___________ is more sensitive index of well-being, illness, or poor nutrition than length or head circumference
Weight
Most commonly used measurement of growth
Full term birth, infant has _______ and _______ that meet the chest at level of _____ rib.
Causes to be more prone to
Short neck and chin
2nd rib
Upper airway obstruction during sleep
Infants are more prone to upper airway upstruction under GETA because
Upper airway muscles are disproportionally sensitive to depressant effects of GETA
Major differences between neonatal and adult airway (2)
Tongue relatively large in proportion to rest of oral cavity = easily obstructs
Larynx is more cephalad in infants (C2-3 vs C4-5)
____ primary teeth. Begin to shed at _____ years
20
6-12 years
Many infants have some degree of ________ which renders supraglottic structure prone to collapse with inspiration
Laryngomalacia
To improve airflow during upper airway obstruction in pediatric airway
Chin lift
Jaw thrust
CPAP 5-15 cm H20 on APL
Avoid nasal trumpets in children with
Coagulopathy and/or thrombocytopenia
Suspicion of traumatic basilar skull fracture
LMA for <5kg
1
LMA for 5-10 kg
1.5
LMA for 10-20kg
2
LMA for 20-30kg
2.5
LMA for 30-50kg
3
LMA for 50-70 kg
4
Formula for selecting correct ETT
Uncuffed
(Age (yrs) + 16) / 4
Formula for selecting cuffed ETT
(Age (yrs) + 16) / 4
Go down at least 1/2 size
ETT depth 1-12 months
10cm
ETT depth 6 year old
14-15cm
ETT depth 10 years old
16-17cm
ETT depth for 16 years old
18-19cm
Black line marking at ETT should rest
Right at vocal cords
Will put tip of ETT between carina and cords
Narrowest part of infants larynx
Cricoid cartilage
5 ways neonatal airway differs from adult airway
- larger tongue
- larynx more cephalad
- epiglottis short, stubby, omega shaped, angled over laryngeal inlet
- angled vocal cords
- infant larynx more funnel shaped,
Purpose of leak test
Prevent airway edema and post intubation stridor
Pattern for depth of ETT
10 + age in years
Laryngospasm elicited by stimulation of _____________
Afferent fibers of internal branch of superior laryngeal nerve
Inspiratory stridor
Partial laryngospasm
No air movement, tracheal tug, paradoxical chest movement, bradycardia, desaturation
Complete laryngospasm
Laryngospasm treatment
- identify and remove stimulus
- jaw thrust
- oral or nasal airway
- positive pressure ventilation 100% 02
- deepen anesthesia with Sevo or 0.5mg/kg Propofol
- 0.1-1mg/kg Succ IV or 4 mg/kg IM
W/ atropine 10-20mcg IV, 20-40mcg IM
Laryngospasm occurs during induction of pediatric patient. IV hasn’t been placed. Which 2 muscle relaxants can be given IM to break laryngospasm in this patient
Succinylcholine or Rocuronium
Succinylcholine dose IM peds
4 mg/kg
2 year old develops laryngospasm postoperatively and becomes bradycardic. Should atropine be given prior, concurrently, or after succinylcholine
Atropine then succinylcholine
Succinylcholine mimics effect of Ach at cardiac muscarinic receptors, which can precipitate more severe bradycardia, junction alone rhythms, or sinus arrest
Limit of viability is
Around 24th week
At limit of viability the lungs develop what (2)
Gas-exchanging surface
Surfactant production begins
Surfactant produced by
Type II pneumocytes
Clinically useful indicator on lung maturity
Lecithin-Sphingomyelin (L/S) ratio
Surfactant secretion increases
Inspiration in infants occurs almost entirely as a result of
Diaphragmatic descent
In awake state of infant what maintains FRC
Sustained inspiratory muscle tension