Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

APEX > Unit 11 - Pediatrics > Flashcards

Unit 11 - Pediatrics Flashcards

1
Q

typical cause of epiglottitis

A

bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

typical cause of croup

A

virus

  • H. parainfluenzae
  • Respiratory syncytial virus
  • Influenza viruses type A & B
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

typical age group affected by epiglottitis

A

2-6 yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

typical age group affected by croup

A

< 2 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

onset of epiglottitis

A

rapid ( < 24 H)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

onset of croup

A

gradual (24-72 hours)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

bacterial infection assoc with croup

A

Mycoplasma pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

region of airway affected in epiglottitis

A

Supraglottic structures (supraglottis)
* Epiglottis
* Vallecula
* Arytenoids
* Aryepiglottic folds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

region of airway affected by croup

A

Laryngeal structures below the vocal cords

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

neck xray findings in epiglottitis vs. croup

A

epiglottitis: thumb sign (swollen epiglottis)
croup: steeple sign (subglottic narrowing)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

s/s epiglottitis

A

High-grade fever
The tripod position helps breathing
4 D’s:
* Drooling
* Dyspnea
* Dysphonia
* Dysphagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

s/s croup

A
  • Low-grade fever
  • Barking cough
  • Vocal hoarseness
  • Inspiratory stridor
  • Retractions: suprasternal, substernal, or intercostal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

treatment of epiglottitis

A
  • Oxygen
  • Urgent airway management
  • Antibiotics if bacterial
  • Induction with spontaneous RR
  • CPAP 10 - 15 cm H2O prevents airway collapse
  • ENT surgeon must be present
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

treatment of croup

A
  • Oxygen
  • Racemic epinephrine
  • Corticosteroids
  • Humidification
  • Fluids
  • Intubation rarely required
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

most common cause of postop laryngeal edema

A

ETT that is too large

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

tracheal mucosa perfusion pressure

A

25 cm H2O

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

s/s post-intubation laryngeal edema

A

hoarseness, a barky cough, and stridor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

typical onset of post-intubation laryngeal edema

A

30 - 60 minutes following extubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

risks for Postintubation Laryngeal Edema

A
  • Age < 4 years
  • ETT is too large
  • ETT cuff volume is too high
  • traumatic or multiple intubation attempts (one reason not to use an uncuffed tube)
  • prolonged intubation
  • coughing (cuff rubs against the tracheal mucosa)
  • head or neck surgery
  • head repositioning during surgery
  • history of infectious or post-intubation croup
  • trisomy 21
  • upper respiratory tract infection?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

key to preventing Postintubation Laryngeal Edema

A

maintain an air leak < 25 cm H2O

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

preferred treatment for post-intubation laryngeal edema

A

Racemic epinephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

dilution of racemic epi

A

2.25% racemic epi diluted in NS
0-25 kg = 0.25 mL epi, 2.5 mL NS
20-40 kg = 0.5 mL epi, 2.5 mL NS
>40 kg = 0.74 mL epi, 2.5 mL NS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

treatments for croup

A
  • racemic epi
  • Cool and humidified oxygen
  • Dexamethasone 0.25 - 0.5 mg/kg IV (maximum effect requires 4 - 6 hours)
  • Heliox
24
Q

how long should patients be observed post-racemic epi admin

A

4 hours minimum

25
Q

how long should elective surgery be delayed in pts with URI

A

2-4 weeks after onset of symptoms

risk of pulmonary complications can persist 6- 8 weeks

26
Q

good reasons to cancel elective surgery in pt with URI

A
  • purulent nasal discharge
  • fever > 100.4
  • lethargic
  • persistent cough
  • poor appetite
  • wheezing/rales that dont clear with cough
  • child < 1 yr or previous preemie
27
Q

considerations for ETT use in pt with URI

A
  • increases risk of bronchospasm 10 fold
  • use a smaller ETT (higher risk post-intubation croup)
  • 0.25-0.5 mg/kg decadron dec risk post extubation croup
  • Pretreatment with an inhaled bronchodilator (albuterol or ipratropium) or glycopyrrolate does not provide a clear benefit
28
Q

classic triad of foreign body aspiration

A
  1. cough
  2. wheezing
  3. decreased breath sounds on affected side
29
Q

s/s supraglottic vs subglottic obstriction

A
  • supraglottic = stridor
  • subglottic = wheezing
30
Q

gold standard procedure to retrieve foreign body

A

Rigid bronchoscopy

31
Q

complications of rigid bronch to retrieve foreign body

A
  • laryngospasm
  • bradycardia during scope insertion
  • post-intubation croup
  • pneumothorax
32
Q

best method of induction for foreign body aspiration

A

spontaneous ventilation (use throughout procedure)
PPV can push FB deeper

33
Q

compromising for leak when using rigid bronch

A
  • increased FGF
  • increased vaporizer output

TIVA with propofol prob best maintenance technique

34
Q

airway concerns with Pierre Robin

A
  • micrognathia or mandibular hypoplasia
  • A tongue that falls back and downwards (glossoptosis)
  • Cleft palate
35
Q

airway concerns with treacher collins

A
  • Small mouth
  • Small/ underdeveloped mandible
  • Nasal airway is blocked by tissue (choanal atresia - you won’t be able to pass a suction catheter past)
36
Q

airway concerns with trisomy 21

A

risk difficult intubation and mask
* Small mouth, large tongue, palate high/narrow arch, midface hypoplasia
* Atlantoaxial instability (avoid neck flexion)
* Small subglottic diameter (subglottic stenosis) -use smaller ETT

37
Q

airway concerns with Goldenhar

A
  • Small/underdeveloped mandible
  • Cervical spine abnormality
38
Q

airway concerns with cri du chat

A
  • Small/underdeveloped mandible
  • Laryngomalacia, stridor
39
Q

airway specific risks with cleft lip/palate

A
  • Airway obstruction
  • Difficult laryngoscopy
  • Difficult mask ventilation if there are additional craniofacial abnormalities
  • Aspiration
40
Q

risks assoc with dingmann-dott mouth retractor for cleft lip/palate repair

A

can reduce venous drainage and cause tongue engorgement - increases the risk of post-extubation airway obstruction

41
Q

when are cleft lip and palate surgeries typicallt performed

A

lip : ~ 1 mo
palate: ~ 12 mo

42
Q

most common CHD in trisomy 21

A

AVSD
#2 = VSD

43
Q

considerations for inhalation induction in trisomy 21 pts

A

bradycardia very common during induction with sevo
carefully increase sevo conc. during inhalation induction

44
Q

VACTERL

A

Vertebral defects
Imperforated anus
Cardiac abnormalities
Tracheoesophageal fistula
Esophageal atresia
Renal dysplasia
Limb anomalies

45
Q

CHARGE syndrome

A

Coloboma
Heart defects
choanal Atresia
Restriction of growth
Genitourinary problems
Ear anomalies

46
Q

CATCH 22 syndrome (Aka digeorge)

A

Cardiac defects
Abnormal face
Thymic hypoplasia
Cleft palate
Hypocalcemia
22 – 22q11.2 gene deletion

47
Q

why is hypocalcemia common with digeorge/catch 22

A

due to hypoparathyroidism

remember hyperventilation, albumin, and citrated blood products lower io

48
Q

blood transfusion considerations in digeorge/catch 22

A

leukocyte-depleted irradiated blood is best
(high risk for infection if thymus is absent)

49
Q

most common indication for peds T&A

A

nocturnal upper airway obstruction and sleep disordered breathing (with or without obstructive sleep apnea)

Also chronic and/or recurrent infections

50
Q

considerations for kids with OSA undergoing T&A

A
  • longer emergence
  • should receive lower opioid dose intraop
  • higher incidence of postop airway obstruction, prolonged O2 requirements
  • admit to hospital for 23 hr obs
  • no codeine postop
51
Q

most common coagulation disorder in pts undergoing T&A

A

von willebrand disease

52
Q

considerations for pts with von willebrand undergoing surgery

A

pts receiving DDAVP are at risk for hyponatermia
* Use isotonic crystalloids at 1/2 - 2/3 of the calculated maintenance values
* also monitor sodium postoperatively

53
Q

when does primary post-tonsillectomy bleeding usually occur

A

within 24 hours
(surgical complication)

54
Q

when do 75% of post-tonsillectomy bleeds occur

A

within first 6 hours of surgery

55
Q

when does secondary post-tonsillectomy bleeding occur

A

5-10 days after surgery
scar covering tonsil bed contracts

56
Q

suggested EBL when post-tonsillectomy bleed pt has dizziness and orthostatic hypotension

A

suggestive of a ≥ 20% loss of circulating volume

57
Q

considerations for post-tonsillectomy bleed pts

A
  • surgical emergency
  • full stomach - RSI
  • volume resuscitation before induction
  • preoxygenate in left-lateral head down (helps blood drain)
  • OGT after induction to decompress stomach

APEX (54 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions