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EM > WK 8- Obstetrics and Paediatrics > Flashcards

WK 8- Obstetrics and Paediatrics Flashcards

1
Q

What respiratory changes occur in pregnancy

A
  • 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
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2
Q

What cardiovascular changes occur in pregnancy

A

increase HR, CO and decrease in BP (dilation of venous vessles due to progesterone) , ECG changes

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3
Q

What haematological changes occur in pregnancy

A

→ 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

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4
Q

What GIT changes occur in pregnancy

A

-weight gain, increase metabolic rate, decrease gut motility, raised diaphragm

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5
Q

What renal changes occur in pregnancy

A

increase in renal blood flow, increase urination, bladder displaced by uterus

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6
Q

What MSK changes occur in pregnancy

A

increase in pubic symphysis width, increase ligament laxity, unstable gait

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7
Q

Why are pregnant ladies difficult to intubate

A

Airway oedema, increase in breast tissue size causes issues with the laryngoscope (have to use a short laryngoscope), reflux, full stomach, decreased resp reserve

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8
Q

Why is blood loss in a pregnant lady so damaging to the fetus
-what is the mortality rate of a shocked pregnant lady

A

-The first place the blood will shunt away from will be uretoplacental circulation-> decreases blood flow to foetus causing hypoxia

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9
Q

What is supine postural hypotension syndrome

A

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

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10
Q

What are the 4 ways to determine a childs weight

A

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

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11
Q

What are the 10 differences between an adult and child’s airway

A

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
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12
Q

What is an implication of children having horizontal ribs

A

-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

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13
Q

What does drooling in an ill child indicate

A

Epiglottitis-> unable to swallow saliva due to irritated epiglottitis

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14
Q

What medication is given to a child in resp distress and by what route

A

Nebulised adrenaline–> decreases airway oedema

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15
Q

How do children increase their CO

-why is this method needed

A

Due to being unable to expand their LV, children have to increase their HR to increase their CO

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16
Q 
What is the normal HR of a child who is; 
1
2
4
8
A 
1= less than 150
2= less than 140
4= less than 120
8= less than 110
17
Q 
What is the normal resp rate for a child who is; 
1
2
4
8
A

<1=less than 50
2=less than 40
4= less than 30
8= less than 20

18
Q

If a child arrests, what would be the main cause- airway or circulation pathology?

A

Mainly always airway

19
Q

What are the differences between an adult and child chest X-ray

A

Children will have a:

  • flat diaphragm
  • horizontal ribs
  • large gastric bubble
  • RV is larger but both ventricles will look equal
  • short trachea
  • large thymus
20
Q 
At what level is the uterus at week:
8
12
20
24
36
40
A 
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
21
Q

What is the foetal mortality rate if the mother has a ruptured appendix

A

35%

22
Q

True or false, there is decreased vital capacity in a pregnant female and why

A

due to pushing thoracic organs upwards, lungs cannot expand fully

23
Q

What are 3 anatomical differences in a female pelvis that allow for pregnancy to occur

A
  • circular inlet in females
  • pubic arch is wider
  • ischial spines do not project inwards
24
Q

Why is knowing the weight of a child important

A

drug dosing→ ie calculating dose for medication/anesthetics/fluids
-metabolism of drugs

25
Q

Why are the left and right ventricle are of equal size at birth

A

→ 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

26
Q

How is BP calculated

A

70+(Age x 2)

27
Q

If a child is severely dehydrated, how much IV fluid bolus should be given

A

10ml/kg

28
Q

Can thiopentone cross the placenta barrier?

A

YES
-if a mother is given thiopentone/propofol, the fetus must be immediately delivered to avoid the drug crossing into foetal circulation

29
Q

Out of warfarin and heparin, which crosses the placent

A

Warfarin–> it is a smaller molecule than heparin so therefore is able to cross the placenta

30
Q

Do lipophilic or highly ionised drugs cross the placenta more quickly

A

Lipophilic cross the placenta rapidly, whilst highly ionised drugs cross slowly

31
Q

What is the MOA of paracetamol

A

-Inhibit COX enzymes and the formation of prostaglandins→ i-peripherally block pain impulse and inhibit hypothalamic heat regulating centre (anti-pyresis)

32
Q

What is the MOA of morphine

A

binds to the mu-opiod receptor and agonises it, causing increased release of dopamine and inhibiting of GABA

33
Q

What methods of administration of fentanyl are useful in the ED in children with acute injuries?

A

intranasal fentanyl

EM (11 decks)

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