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Pediatrics > Test 1 > Flashcards

Test 1 Flashcards

1
Q

1kg = _____g

A

1kg = 1000g

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2
Q

1g = ______ mg =______mcg

A

1g = 1000mg = 1,000,000mcg

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3
Q

PO Midazolam

A

0.5-0.7 mg/kg

MAX 20 mg

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4
Q

Propofol IV

A

2-4 mg/kg

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5
Q

Succinylcholine

A

1.5-2 mg/kg

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6
Q

Atropine

IV

IM

A

IV 10-20mcg/kg (min 0.1mg)

IM 20-40 mcg/kg

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7
Q

Cefazolin

A

30mg/kg

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8
Q

Vecuronium

A

0.1mg/kg

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9
Q

Fentanyl

A

1-2 mcg/kg

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10
Q

Hydromorphone

A

10-20 mcg/kg

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11
Q

Morphine

A

0.1 mg/kg

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12
Q

Suggamadex

A

2-4 mg/kg

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13
Q

Glycopyrrolate

A

10 mcg/kg

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14
Q

Neostigmine

A

0.07 mg/kg

MAX 5 mg

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15
Q

Ondansetron

A

0.1 mg/kg

MAX 4 mg

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16
Q

Ketorolac

A

0.5 mg/kg

MAX 30 mg

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17
Q

Infants weighing less than 2500gm at birth known as

A

Prematurity

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18
Q

Infant born before 37 weeks

A

Preterm

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19
Q

Infant born between 37 and 42 weeks

A

Term infant

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20
Q

Infant born after 42 weeks

A

Post-term

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21
Q

5 ways premature infant different from full term neonate

A

Less able to:

  • suck
  • maintain body temp
  • swallow
  • eat
  • sustain ventilation
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22
Q

Definition of neonate

A

<30 days

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23
Q

Definition of infant

A

1-12 months

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24
Q

Definition of child

A

1-12 years

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25
Q

Definition of adolescent

A

13-19 years

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26
Q

Low birth weight

A

Less than 2.5 kg

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27
Q

Extremely low birth weight

A

Less than 1 kg

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28
Q

Very low birth weight

A

Less than 1.5 kg

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29
Q

Micro-preemie

A

Less than 750 gm

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30
Q

Deviation in relationship between duration of gestation and weight of infant may be associated with

A
  • inadequate maternal nutrition
  • significant maternal disease
  • maternal toxins
  • fetal infections
  • genetic abnormalities
  • fetal congenital malformations
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31
Q

___________ is more sensitive index of well-being, illness, or poor nutrition than length or head circumference

A

Weight

Most commonly used measurement of growth

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32
Q

Full term birth, infant has _______ and _______ that meet the chest at level of _____ rib.

Causes to be more prone to

A

Short neck and chin

2nd rib

Upper airway obstruction during sleep

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33
Q

Infants are more prone to upper airway upstruction under GETA because

A

Upper airway muscles are disproportionally sensitive to depressant effects of GETA

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34
Q

Major differences between neonatal and adult airway (2)

A

Tongue relatively large in proportion to rest of oral cavity = easily obstructs

Larynx is more cephalad in infants (C2-3 vs C4-5)

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35
Q

____ primary teeth. Begin to shed at _____ years

A

20

6-12 years

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36
Q

Many infants have some degree of ________ which renders supraglottic structure prone to collapse with inspiration

A

Laryngomalacia

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37
Q

To improve airflow during upper airway obstruction in pediatric airway

A

Chin lift

Jaw thrust

CPAP 5-15 cm H20 on APL

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38
Q

Avoid nasal trumpets in children with

A

Coagulopathy and/or thrombocytopenia

Suspicion of traumatic basilar skull fracture

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39
Q

LMA for <5kg

A

1

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40
Q

LMA for 5-10 kg

A

1.5

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41
Q

LMA for 10-20kg

A

2

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42
Q

LMA for 20-30kg

A

2.5

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43
Q

LMA for 30-50kg

A

3

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44
Q

LMA for 50-70 kg

A

4

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45
Q

Formula for selecting correct ETT

Uncuffed

A

(Age (yrs) + 16) / 4

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46
Q

Formula for selecting cuffed ETT

A

(Age (yrs) + 16) / 4

Go down at least 1/2 size

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47
Q

ETT depth 1-12 months

A

10cm

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48
Q

ETT depth 6 year old

A

14-15cm

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49
Q

ETT depth 10 years old

A

16-17cm

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50
Q

ETT depth for 16 years old

A

18-19cm

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51
Q

Black line marking at ETT should rest

A

Right at vocal cords

Will put tip of ETT between carina and cords

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52
Q

Narrowest part of infants larynx

A

Cricoid cartilage

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53
Q

5 ways neonatal airway differs from adult airway

A
  • larger tongue
  • larynx more cephalad
  • epiglottis short, stubby, omega shaped, angled over laryngeal inlet
  • angled vocal cords
  • infant larynx more funnel shaped,
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54
Q

Purpose of leak test

A

Prevent airway edema and post intubation stridor

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55
Q

Pattern for depth of ETT

A

10 + age in years

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56
Q

Laryngospasm elicited by stimulation of _____________

A

Afferent fibers of internal branch of superior laryngeal nerve

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57
Q

Inspiratory stridor

A

Partial laryngospasm

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58
Q

No air movement, tracheal tug, paradoxical chest movement, bradycardia, desaturation

A

Complete laryngospasm

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59
Q

Laryngospasm treatment

A
  • 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
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60
Q

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

A

Succinylcholine or Rocuronium

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61
Q

Succinylcholine dose IM peds

A

4 mg/kg

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62
Q

2 year old develops laryngospasm postoperatively and becomes bradycardic. Should atropine be given prior, concurrently, or after succinylcholine

A

Atropine then succinylcholine

Succinylcholine mimics effect of Ach at cardiac muscarinic receptors, which can precipitate more severe bradycardia, junction alone rhythms, or sinus arrest

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63
Q

Limit of viability is

A

Around 24th week

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64
Q

At limit of viability the lungs develop what (2)

A

Gas-exchanging surface

Surfactant production begins

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65
Q

Surfactant produced by

A

Type II pneumocytes

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66
Q

Clinically useful indicator on lung maturity

A

Lecithin-Sphingomyelin (L/S) ratio

Surfactant secretion increases

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67
Q

Inspiration in infants occurs almost entirely as a result of

A

Diaphragmatic descent

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68
Q

In awake state of infant what maintains FRC

A

Sustained inspiratory muscle tension

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69
Q

Under GETA in infants what occurs in relation of airway

A

Inspiratory muscle tension abolished and FRC collapses -> airway closure and atelectasis unless CPAP or PEEP maintained

70
Q

Recurrent pauses in ventilation lasting _________ with alternating bursts of respiratory activity is normal

A

5-10 seconds

71
Q

Surgery in neonates poses a major concern- development of apnea in post-op period. Which neonates at highest risk? (4)

A
  • prematurely born
  • multiple congenital anomalies
  • hx of apnea and bradycardia
  • chronic lung disease
72
Q

Risk of postanesthetic respiratory depression is inversely related to

A

Gestational age and post conceptual age(PCA)

73
Q

PCA is

A

Sum of gestational age and chronological age

74
Q

Criteria for discharge from PACU

Should be admitted

A

< 55 weeks PCA

Anemic (HCt <30%)

Ongoing apnea

75
Q

Criteria to discharge from PACE

Observed for extended time and later discharged if stable

A

Former preterm infants 55-60 weeks PCA

Not anemic

No apnea

76
Q

URI may

A

Increase airway sensitive, cause desaturation, laryngospasm, bronchospasm, breath holding, severe coughing

77
Q

When should elective surgery be postponed r/t URI

A

Mucopurulent secretions

Productive cough

Fever >100.4

Pulmonary involvement

78
Q

Asthma is characterized by

A

Variable and recurring symptoms

Airway obstruction

Inflammation

Hyperresponsiveness of airways

79
Q

Should be given shortly after induction to pt with asthma

A

B2 agonist

Corticosteroids

80
Q

Tx of intra-op bronchospasm

A

Deepen anesthesia/analgesia

Increase Fi02

Increase expiratory time (1:2.5)

Repeat Beta 2 agonist

If severe epi 10-20 mcg IV or ETT

81
Q

At what conceptual age is surfactant developed

A

23-34 weeks and increases in concentration during last 10 weeks of gestation

82
Q

Infant patient is high-risk for post-op apnea. What agent may be given prophylactically to decrease risk of apnea?

A

Caffeine 10mg/kg

83
Q

Would a formerly premature infant be a candidate for outpatient surgery?

What are anesthetic concerns?

A

No.

<55 weeks PCA increased risk of post-op apnea and bradycardia

Formerly premature infants should have cardiorespiratory monitoring for minimum of 24 hours

84
Q

How many breaths per minute should be produced by ventilator for neonate? Adult?

A

30-50 for infant

12-16 for adult

85
Q

How do infants react to hypoxia?

A

Bradycardia progressing to cardiac arrest

86
Q

What is appropriate internal diameter of ETT for premature newborn? Full term newborn?

A
  1. 5-3.0 mm for premature (uncuffed)

3. 0-3.5 full term (uncuffed)

87
Q

What size ETT and length for neonat, 2yo, 6yo, and 10yo?

A

Neonate- 3.0-3.5. 10 cm

2yo- 4.5 and 13 cm

6yo- 5.5 and 15cm

10yo- 6.5 and 17cm

88
Q

Why are infants more prone to airway obstruction than adults?

A

Proportionally larger tongue than adults

89
Q

How does chest wall compliance and pulmonary compliance differ in neonate compared with adult?

A

Increased chest wall compliance and decreased pulmonary compliance

Chest wall easer to dissent bu lung is more difficult to distend

90
Q

In newborn closing capacity is higher than FRC. This means

A

Some airways close during expiratory phase of normal tidal breathing

91
Q

Why is subglottic stereos is more severe in peds patient than adult

A

Relatively small cross-sectional area in peds

Small amount of swelling can rapidly occlude airway

92
Q

What is tidal volume of neonate in ml/kg?

93
Q

What is minute volume per kg for neonate?

A

Minute ventilation = TV X RR

94
Q

Foramen Ovale allows flow where

95
Q

Ductus arteriosus allows flow where

A

PA to Aorta

96
Q

Fetal circulation:

of umbilical veins and arteries

A

1 umbilical vein

2 umbilical arteries

97
Q

What allows flow to bypass liver

A

Ductus venous

98
Q

Fetal circulation

Which is higher PVR or SVR

A

high PVR

Low SVR

99
Q

What causes closure of foramen ovale

A

As breathe lungs inflate reducing PVR. SVR increases after umbilical cord cut.

As LA pressure increases over RA pressure the flap closes shutting the foramen ovale

100
Q

What causes closure of ductus arteriosus

A

Reduced levels of prostaglandins causes closure of DA and FO within days after birth

101
Q

Blood shunt through what two structures in the neonate with persistent fetal circulation

A

Blood shunt through ductus arteriosus and foramen ovale

102
Q

During early neonatal period hypoxia causes what

A

Reversion to fetal circulation.

PVR increases and reopens foramen ovale and/or ductus arteriosus

103
Q

Hypoxia causes (4)

A

Pulmonary vasoconstriction (increased PVR)

Systemic vasodilation (decreased SVR)

Bradycardia

Decreased cardiac output

104
Q

ANS in neonates is predominately

A

PNS

Slowly improving SNS

105
Q

Cardiac output in neonates is largely dependent on what?

Why?

A

CO is rate dependent

Fixed stroke volume

106
Q

Less compliant LV in neonate is dependent on

A

Rate and adequate filling

107
Q

Hypovolemia in neonate is followed by

A

Fall in cardiac output

108
Q

2 ways physiology of CV system of neonate differed from that of the adult

A

CO is heart rate dependent

LV compliance is decreased

109
Q

Appropriate heart rate range for term infant

When do you do CPR

A

120-180

Rate <100 CPR

110
Q

Infants systolic arterial BP is closely r/t

A

Circulating blood volume

111
Q

Neonate H/H

A

Hct 60%. Hgb 18-19

112
Q

Most Hgb in neonate is what type? Impact

A

Fetal Hgb

Higher affinity for O2. Shifts oxyhemoglobin curve to LEFT

113
Q

During the first few months of life what occurs with Hgb

A

H/H decline steadily and HgbF replaced by HgbA

O2 delivery to tissues not compromised and curve shifts to the RIGHT

114
Q

Hgb concentration at 2 weeks, 2-3 months, and 2 years

A

2 weeks- 13-19

2-3 months 10-11

2 weeks <12.5

115
Q

4 ways children pharmacokinetics differ from adults

A

Altered protein binding

Larger volume of distribution

Smaller proportion of fat and muscle stores

Immature renal and hepatic function

116
Q

When do liver enzymes become completely functional in the neonate

A

Cytochrome P450 enzyme is fully functional at 1 month of age

117
Q

Physiologic jaundice is due to

A

Breakdown of RBCs release bilirubin and the newborn liver is immature and cannot conjugate

118
Q

Grave form of jaundice of newborn characterized by

A

High levels of unconjugated bilirubin in blood

Degenerative lesions in cerebral gray matter

Kernicterus (bilirubin encephalopathy)

119
Q

What drugs may cause kernicterus in the neonate

A

Furosemide

Sulfonamides

Diazepam

120
Q

What causes kernicterus

A

Toxic effects of unconjugated bilirubin on CNS

121
Q

S/S of kernicterus

A

Hypertonicity

Opisthotonos

Spasticity

122
Q

Number one condition associated with apnea and bradycardia in preterm infants

123
Q

Fetal pancreas secretes insulin from when

A

11th week of fetal life

124
Q

Uncontrolled maternal hyperglycemia results in

A

Hypertrophy and hyperplasia of fetal islets of Langerhans

Increased levels of insulin in fetus

125
Q

Increased levels of insulin in fetus results in

A

Affects lipid metabolism giving rise to large, overweight infants

126
Q

Hyperinsulemia of fetus persists after birth and may lead to

A

Serious hypoglycemia which can lead to irreversible CNS damage

127
Q

To prevent hyperglycemia during GETA in neonates

A

dextrose free IVF (LR) should replace small blood loss, third spacing, and deficit fluid losses

128
Q

Insensible fluid losses in infancy

A

Relatively high due to high respiratory rate and thin skin of LBW infants

129
Q

Infants have limited ability to do what which leads to dehydration developing rapidly

A

Limited ability to concentrate urine and conserve water

130
Q

2 limitations of kidney function in newborn and significance

A

GFR 15-30% of normal adult- decreased ability to concentrate urine

Tolerate water and salt loads poorly

131
Q

Pre op NPO recommendations

Clears

Gum

Breast milk

Formula/light meals

Solids (fatty)

A

Clears and gum 2 hours

Breast milk 4 hours

Formula/light meals. 6 hours

Solids (fatty) 8 hours

132
Q

Infants are predisposed to hypothermia due to what

A

Large skin surface compared to body mass ratio

Evaporative heat loss greater

Reduced keratin content

Diminished efficacy of thermoregulatory response

133
Q

Impact of volatile and regional anesthetics in infants in relation to thermoregulation

A

Cause vasodilation = greater blood flow to surface of bodies

Disrupt thermoregulatory mechanism

134
Q

Most perioperative heat loss is due to

A

Environment

135
Q

First hour heat loss during surgery is due to

A

Core-to-peripheral redistribution of body heat

136
Q

4 primary processes of heat loss in patients

A

Radiation

Convection

Conduction

Evaporation

137
Q

Most significant mechanism of heat loss by out bodies

138
Q

Transfer of energy between 2 objects that are not in direct contact but differ in temperature

139
Q

What part of bodies lose greatest amount of heat

140
Q

Process of creating air currents by heat

A

Convection

141
Q

Convection MOA in bodies

A

Transfer kinetic energy to air molecules on surface of skin. Heated air molecules replaced by colder air molecules

142
Q

What percent of total heat loss from body occurs from radiation and convection

A

Radiation 40%

Convection 30%

Total 70%

143
Q

Moisture evaporated from the patients skin as well as through the respiratory tract

A

Evaporation

144
Q

Which route does a burn patient lose the highest percentage of body heat

A

Evaporation

145
Q

Transfer of heat by physically in direct contact with less warm object

A

Conduction

146
Q

Rank routes of heat loss

A

Radiation

Convection

Evaporation

Conduction

147
Q

5 ways to prevent heat loss in OR

A

Using forced warm air devices

Lower FGF

Humidification systems

Warming the OR

Covering and insulating patients

148
Q

Infants rely primarily on what to generate heat

A

Non-shivering thermogenesis

149
Q

Brown adipose tissue is located where

A

Scapulae, axillary, mediastinum, around kidneys/adrenal glands

150
Q

Physiology of brown fat temperature homeostasis

A

Brown color caused by abundance of mitochondria that are able to uncouple oxidative phosphorylation, resulting in heat production

151
Q

Non shivering thermogenesis may persist up to age of

152
Q

What reduces nonshivering thermogenesis in infants (anesthetics)

A

Inhalation agents

Propofol

Fentanyl

153
Q

Cold stress and hypothermia affects

A

Recovery from anesthetic and relaxant drugs

Impairs coagulation

Depress ventilation

Dysrhythmia

Increased post-op 02 consumption

154
Q

Significance of brown fat?

A

Cold stress resulting in increased NE production, enhances metabolism of brown fat and increased body heat

155
Q

Body responses during hyperthermia stress are limited to

A

Active vasodilation and sweating

156
Q

Posterior fontanelle closes when

157
Q

Anterior fontanelle closes when

A

9-18 months

158
Q

Autoregulation of CBF is dependent on what

A

Pressure dependent

159
Q

Predisposing factors for intracranial hemorrhage

A

Hypoxia

Hypercapnia

Hypernatremia

Functuations in arterial/venous pressure or CBF

Low Hct

Overtransfusion

Rapid administration of hypertonic fluids (dextrose/bicarb)

160
Q

Retinopathy of prematurity occurs in

A

50% of extremely low birth weight infants

161
Q

During anesthesia for premature and term neonates do what to prevent retinopathy of prematurity

A

02 saturations between 90%-95% and avoid significant fluctuations in 02 sat

162
Q

At what gestation age does the risk of retinopathy of prematurity become negligible

A

After 44 weeks postconception age

163
Q

Neonatal retrolental fibroplasia is a result of oxygen toxicity above what % Fi02

A

Above 40% oxygen

164
Q

Ophthalmology cases

If eye looks upward do what

A

Increase anesthesia depth

165
Q

Ophthalmology cases

Eye rotates down

A

Decrease anesthesia depth

166
Q

Most common cause for liver transplantation in children

A

Cholestatic liver disease secondary to biliary atresia

167
Q

Pediatric fluid replacement for blood loss is best determined by which method of monitoring

168
Q

4 reasons why difficult to keep newborns warm

A

Large surface area to body weight ratio

Cannot compensate by shivering

Limited to subcutaneous fat for insulation

Limited stores of brown fat and unstable thermoregulatory systems

169
Q

What route do infants lose most of body heat

170
Q

Newborns produce heat primarily by what mechanism

A

Non-shivering thermogenesis of metabolism of brown fat

171
Q

What controls non-shivering thermogenesis in infants

A

Autonomic nervous system

172
Q

Best way to maintain infants body heat

A

Maintain high ambient termperature

Pediatrics (6 decks)

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