WK 8- Obstetrics and Paediatrics Flashcards
What respiratory changes occur in pregnancy
- airway size decreases (due to oedema produced by progesterone), breast tissue increases in size (difficulty placing laryngoscope in mouth)
- total lung volume stays the same but due to breathing for 2, the tidal volume will increase
- To accomodate for the increased tidal volume, but lung size staying the same, the resp reserve decreases
- Get respiratory alkalosis (breathing more frequently= decrease C02= causes increase in H+ output (decrease conc=alkalosis)
- increased 02 consumptions to due increased metabolism
- dyspnoea, foetal Hb
What cardiovascular changes occur in pregnancy
increase HR, CO and decrease in BP (dilation of venous vessles due to progesterone) , ECG changes
What haematological changes occur in pregnancy
→ increase in blood volume by 40%, increase in RBC, decrease in Hb, WBC
-maternal blood volume will have increased by 1.5L by the third trimester
What GIT changes occur in pregnancy
-weight gain, increase metabolic rate, decrease gut motility, raised diaphragm
What renal changes occur in pregnancy
increase in renal blood flow, increase urination, bladder displaced by uterus
What MSK changes occur in pregnancy
increase in pubic symphysis width, increase ligament laxity, unstable gait
Why are pregnant ladies difficult to intubate
Airway oedema, increase in breast tissue size causes issues with the laryngoscope (have to use a short laryngoscope), reflux, full stomach, decreased resp reserve
Why is blood loss in a pregnant lady so damaging to the fetus
-what is the mortality rate of a shocked pregnant lady
-The first place the blood will shunt away from will be uretoplacental circulation-> decreases blood flow to foetus causing hypoxia
What is supine postural hypotension syndrome
weight from amniotic fluid/fetus will cause occlusion of the IVC-> prevents blood return to the heart-> decreasing CO and causing hypotension
-always need to wedge the right hip to reduce pressure off the IVC
What are the 4 ways to determine a childs weight
ask the parent, devised (age x 4 +2), broselow (coloured tape that identifies the length of child and what type/size of equipment needed), guess
What are the 10 differences between an adult and child’s airway
HEAD→ kids have a big head relative to their body (can cause head to tilt forward and occlude airway)
- NECK→ soft neck
- NOSE→ can breastfeed and breathe at same time (obligatory nasal breathers)
- SOFT TISSUE→ tongue is big relative to their mouth
- JAW→ jaw is quite small, relative to their mouth→ makes intubation difficult
- TEETH→ loose and can be easily knocked out→ can occlude bronchus if knocked out during intubation
- TONGUE→ big compared to the mouth
- TONSILS→ big tonsils that meet in the midline→ have to put laryngoscope straight in, not turn
- EPIGLOTTIS→ large, anterior (harder to see the vocal chords) and floppy
- LARYNX→ anterior
- CRICOID→ narrowest part of child’s airway (specifically the ring)
- TRACHEA→ short and malleable (soft)→ don’t need to push that much of the endotracheal tube down→ stop at the black line
What is an implication of children having horizontal ribs
-They are unable to bucket handle their ribs–> unable to expand chest cavity/lung volume–>have to increase their resp rate to increase O2 intake
What does drooling in an ill child indicate
Epiglottitis-> unable to swallow saliva due to irritated epiglottitis
What medication is given to a child in resp distress and by what route
Nebulised adrenaline–> decreases airway oedema
How do children increase their CO
-why is this method needed
Due to being unable to expand their LV, children have to increase their HR to increase their CO
What is the normal HR of a child who is; 1 2 4 8
1= less than 150 2= less than 140 4= less than 120 8= less than 110
What is the normal resp rate for a child who is; 1 2 4 8
<1=less than 50
2=less than 40
4= less than 30
8= less than 20
If a child arrests, what would be the main cause- airway or circulation pathology?
Mainly always airway
What are the differences between an adult and child chest X-ray
Children will have a:
- flat diaphragm
- horizontal ribs
- large gastric bubble
- RV is larger but both ventricles will look equal
- short trachea
- large thymus
At what level is the uterus at week: 8 12 20 24 36 40
8= not palpable 12= just above pubis 20= at the umbilicus 24= at the ribs 36= xiphisternum 40=dropped below xiphisternum as moves into the pelvis
What is the foetal mortality rate if the mother has a ruptured appendix
35%
True or false, there is decreased vital capacity in a pregnant female and why
due to pushing thoracic organs upwards, lungs cannot expand fully
What are 3 anatomical differences in a female pelvis that allow for pregnancy to occur
- circular inlet in females
- pubic arch is wider
- ischial spines do not project inwards
Why is knowing the weight of a child important
drug dosing→ ie calculating dose for medication/anesthetics/fluids
-metabolism of drugs
Why are the left and right ventricle are of equal size at birth
→ fetus doesn’t use lungs to oxygenate blood, so the blood will pass equally from right ventricle to left ventricle through foramen ovale→ no unbalanced pressure causing hypertrophy
How is BP calculated
70+(Age x 2)
If a child is severely dehydrated, how much IV fluid bolus should be given
10ml/kg
Can thiopentone cross the placenta barrier?
YES
-if a mother is given thiopentone/propofol, the fetus must be immediately delivered to avoid the drug crossing into foetal circulation
Out of warfarin and heparin, which crosses the placent
Warfarin–> it is a smaller molecule than heparin so therefore is able to cross the placenta
Do lipophilic or highly ionised drugs cross the placenta more quickly
Lipophilic cross the placenta rapidly, whilst highly ionised drugs cross slowly
What is the MOA of paracetamol
-Inhibit COX enzymes and the formation of prostaglandins→ i-peripherally block pain impulse and inhibit hypothalamic heat regulating centre (anti-pyresis)
What is the MOA of morphine
binds to the mu-opiod receptor and agonises it, causing increased release of dopamine and inhibiting of GABA
What methods of administration of fentanyl are useful in the ED in children with acute injuries?
intranasal fentanyl
