The Basics of Pediatrics

Question 1

Anatomic differences in kids: head, Tongue, location of larynx, hypertrophied tissue, epiglottis?

Answer 1

Larger occiput-neck flexion is not required to attain sniffing position.
Hypertrophied tonsil and adenoid tissue
More cephalic larynx (C3-C4 in term infant, and C4-C5 in adult)
shorter epiglottis, cricoid cartilage is narrowest part, larger tongue in proportion to oral cavity

Question 2

Formula for pedi ETT? NG/OG/Foley-how big? How far do you put it into the trachea? We using cuffed or uncuffed?

Answer 2

(age/4) + 4 (formula for uncuffed tubes)
NG/OG/Foley: 2x ETT
To put it into the trachea: 3x ETT
We’re using uncuffed in kids under 8

Question 3

Why are infants prone to desaturation?

Answer 3

Because they have increased O2 consumption coupled with a relatively decreased FRC leading to hypoxia and bradycardia

Question 4

Tell me about closing volumes and MV/FRC ratio in kids. What about the percentage of vessel rich tissues? What about their blood gas partition coefficient?

Answer 4

They have high closing volumes and a high MV/FRC ratio. This causes them to have a faster inhalation induction. Higher percentage of the neonates’ body weight of vessel rich tissues. Their blood gas partition coefficient for volatile anesthetics is lower

Question 5

What is the primary contributor to ventilation in kids? what do they do when they have an increased oxygen demand?

Answer 5

Primary contributor: diaphragm, with increased O2 demand-they can increase their respiratory rate

Question 6

Infant’s cardiac output is ____ dependent:

What are causes of decreased heart rate in infants?

Answer 6

Rate dependent

Causes of decreased HR in infants: hypoxemia, and vagal stimulation

Question 7

Temperature regulation in infants-how is it maintained?
Do infants shiver?
Why is it difficult for them to maintain normothermia?

Answer 7

its maintained via brown fat metabolism, crying, and movement. Infants DO NOT shiver.
Difficult to maintain normothermia due to increased body surface area, increased metabolic rate, and thinner layer of subcutaneous body fat.

Question 8

Infants and renal issues: Whats decreased, which meds will affect this?

Answer 8

Decreased GFR and RBF, these values do increase rapidly by 3 months of age. Aminoglycosides and muscle relaxants are things that can be affected by that decreased GFR and RBF

Question 9

What are the maintenance fluid requirements for kids?

Answer 9

4 mL/kg/hr for 1st 10 kg
2 mL/kg/hr for 2nd 10 kg plus
1 mL/kg/hr for each remaining kg

Question 10

What is the estimated blood volume (EBV) for kids: 
premature: 
Full term: 
Infant: 
child:

Answer 10

Premature: 90
Full: 85
Infant: 80
Child 75 
Adult: 70 male and 65 female

Question 11

Newborn resp/HR/ and minimum acceptable blood pressure:

Answer 11

resp: 45-60
HR: 100-180
Minimum acceptable blood pressure: Mean BP >/ PCA

Question 12

3 mos-2 yrs resp, HR, min acceptable bp?

Answer 12

Resp: 30
HR 80-150
BP: SBP >/70 + 2x age

Question 13

2-10 years, resp, hr, bp?

Answer 13

resp: 25
hr: 70-110
BP: >/70 + 2 x age

Question 14

Greater than 10 years:

Answer 14

Resp: 20
HR: 50-90
SBP: >/ 90

Question 15

Babies and glucose-does it get low or high? why? Which fluids should you give?

Answer 15

They are prone to hypoglycemia due to increased metabolic demands and decreased glycogen stores. IV dextrose D5 0.25 NS or D10 W should be used in all patients under 6 mos of age, and in infants between 6-12 mos if surgery is expected to last longer than one hour Maintain serum glucose levels above 40

Question 16

What are indications for dextrose administration?

Answer 16

Infants under 6 mos of age, and 6-12 mos if surgery is anticipated to last longer than 1 hour, hx of liver disease, TPN administration, newborn infants of diabetic moms

Question 17

NPO guidelines:

Answer 17

2 hours clear
breast milk: 4 hours 
formula 6 hours 
non-human milk 6 hours 
Meal with fat: 8 hours

Question 18

Fetal hemoglobin curve is shifted to left or right? When does the physiologic fall of hemoglobin start?

Answer 18

To the left
As fetal hemoglobin decreases, there is a physiologic fall in the infant’s hematocrit starting at 6-8 weeks and peaking 12 weeks