Procedures

Question 1

Chest tube size in a child calculation

Answer 1

<div>A commonly used calculation for pediatric chest tube size is derived from the calculation of the endotracheal tube (ETT) size:</div>

<ul><li>ETT = (age/4) + 4 (formula for<em>uncuffed</em>tubes)</li><li>2 x ETT = NG/ OG/ foley size</li><li>3 x ETT = depth of ETT insertion</li><li>4 x ETT = chest tube size (maximum, ie hemothorax)</li></ul>

<div>This patient is 4 years old, so the ETT size = 5.0. The chest tube size, in this patient with a presumed hemo-pneumothorax, would be 20Fr.</div>

Question 2

When performing a FAST exam and assessing the spleno-renal (peri-splenic) window, which of the following is the most likely location for free fluid to accumulate?

Answer 2

Between the spleen and the diaphragm

Question 3

Where is the best place to insert a central line in a hypothermic patient?

Answer 3

<b>Femoral vein.</b><div>In hypothermic patients, the myocardium is extremely irritable and high central lines (internal jugular vein, subclavian) should be avoided as the guide-wire can predispose to arrhythmia.</div>

Question 4

In trauma, Identify the best window according to trauma type

Answer 4

“Blunt trauma: Morrison’s pouch<div>Penetrating trauma: Cardiac</div>”

Question 5

What is the most appropriate amount of packed red blood cells to transfuse in order to raise the hemoglobin by approximately 2g/dL in peds?

Answer 5

<div>The usual transfusion volume of packed red blood cells to raise hemoglobin concentration by 2-3g/dL is 10-15 mL/kg. Infants typically require 15mL/kg of transfusion volume, as their red blood cell concentrations are usually more concentrated than in older children. This patient has a weight of 15kg, so the expected transfusion volume is 150-225cc.</div>

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Question 6

Size of ETT in peds

Answer 6

<p>For uncuffed= (Age/4)+4</p>

<p>For cuffed, use the above formula then subtract 1/2.</p>

Question 7

What is theInitial ventilator settings for intubated patients with status asthmaticus

Answer 7

<ul> <li>tidal volume 8mL/kg,</li> <li>respiratory rate starting at 10/min (square inspiratory flow of 60L/min),</li> <li>PEEP = 0,</li> <li>Fraction inspired oxygen (FIO2) starting at 40% and adjusted for an SpO2 ≥88%,</li> <li>inspiratory:expiratory ratios should be 1:5 or less to promote full exhalation (and prevent breath-stacking).</li> <li>Permissive hypercapnea is appropriate in asthma patients, as the importance is adequate ventilation and the prevention of hypoxia and barotrauma.</li> </ul>

Question 8

What is the indications of pericadiocentesis during FAST exam?

Answer 8

Rt. atrial collapse in diastole