Whats the difference between me and you

Question 1

Difference in paediatric airway anatomy

Answer 1

• relatively larger heads
• narrow nostrils
• newborns are obligate nose breathers
  -short neck
  -large tongue
  -smaller and shorter and more compressible airways
  -higher larynx
  -epiglottis is floppy and narrower
  -narrowest part is now understood to be the glottis, like in adults
  -howeeveer narrower airways results in increase resistance
  -softer palate
  -risk of bud injury during intubation
  -

Question 2

Differences in paediatric respiratory physiology

Answer 2

• FRC is still 30ml/kg but..
• more compliance chest (makes it easier to collapse/derecruit for intubation)
• expiration pressures are close to closing pressure, and the sick/anthesied child will derecruit

Question 3

Shoulder position for intubation of a peds

Answer 3

neck slightly extended - NOT hyperextended

Question 4

Congenital syndromes associated with unfavourable airway anatomy

Answer 4

T21
Pierre robin
treeacher collins
Klippel-Feil

Question 5

difference of invasive monitoring in kids vs adults

Answer 5

• Differences in children and adults
○ The risk in children in higher for invasive monitoring and this alters the risk:benefit ratio
Sampling anemia is a major issue
fluid patency

Question 6

Difference in shock in peds vs adult

Answer 6

Vasodilatory shock is less common and is difficult to detect clinically
hypotension is a late featuyre
low absolute circulating volume in infants and children
in infants, increase CO occurs predominately as a result of increase HR

Question 7

difference in neonates for shock

Answer 7

consider duct dependent lesion
pulmonary HTN may be a significant contributor to shock
signs of shock may be subtle and mimic other diseases

Question 8

What are some vague signs in infants that might mimic shock

Answer 8

the presence of hypotension is not necessary in order to dx shock
In infants an neonates poor feeding, abdominal distension and irritability can all be early warning signs of shock
lab evidence of shock includes elevated lactate and a metabolic acidosis coupled with an increase in Anion gap