BCCH

Question 1

NICU pH, pO2, pCO2, bicarbonate, BE, spO2

Answer 1

7.25-7.45, 50-80, 45-55, 22-26, 0+-2, sats <36 = 88-92, >/=36 = 90-95

Question 2

PICU Vt, RR, Ti, VE, PEEP

Answer 2

6-8ml/kg, 10-30 br/min, 0.6-1.2sec, 100-200ml/min/kg, 5-10 cmh2o

Question 3

NICU Vt, Ti, RR, VE, PEEP

Answer 3

Vt = 4-6ml/kg, Ti= 0.35 - 0.55, RR 40-60, VE = 200-300ml/min/kg, PEEP = 5-8

Question 4

Croup: area + degree of obstruction, age, common causes, signs, tx

Answer 4

Laryngotracheobronchitis; inflammation of larynx/cords, trachea, bronchi; partial-complete obstruction; age = 6 mo-3 yr; seasonal due to viral etiology: parainfluenza 1 +3, influenza a+b, rsv, rhinov, corona, HMV, adenovirus; signs: increased WOB, Barky cough, insu stridor, fever, hypoxemia (severe); dx: signs + hx adequate (cxr steeple sign but not necessary). Tx: neb epi, corticosteroids

Question 5

describe coronary circulation

Answer 5

LV - aortic valve - ascending aorta - brachiocephalic artery>right carotid>RA and RV supply & left carotid>circumflex (LA and posterior LV supply) + left anterior descending artery (critical, supplies anterior and inferior LV)

Question 6

Why PPV is beneficial for CHF Pts? (hint: aortic wall tension)

Answer 6

PPV generally sucks for heart (collapses IVC & RA, decreased RV preload, increased RV afterload, decreased LV preload and compliance) but PPV actually reduces LV afterload!!!

• this is bc with PPV, Ppl becomes more positive
• LV afterload is represented by aortic wall tension (bc that is what the LV has to pump against)
• aortica wall tension (T) = Ptm x r / 2 according to Laplace’s law: P = 2T/r
• Ptm = vascular pressure - Ppl
• so PPV makes Ppl more positive which makes Ptm smaller and therefore aortic wall tension decreases = LV afterload decreases
• PPV is like mechanical milrinone for the LV in CHF pts: + pressure assists LV contraction to overcome aortic valve opening + decreases the LV afterload

Question 7

7 acyanotic heart defects + how to tell which ventricle is resulting in dilation

Answer 7

atrial septal defect, VSD, AVSD, PDA, RVOTO/pulmonic stenosis, aortic stenosis, coarctation of aorta
= L to R shunt
-dilation = stenosis of ventricle (pressure loaded) or receiving the volume of shunt (volume loaded)

Question 8

6 cyanotic heart defects + memory trick

Answer 8

any that starts with 
"T"
-tetralogy of fallot
-tricuspid atresia
-transposition of the Great Arteries
-total anomalous pulm venous return
-truncus arteriosus
-hypoplastic left heart syndrome
= R to L shunt

Question 9

SVR and PVR eqn

Answer 9

SVR = MAP-CVP / CO
PVR = PAP - PCWP/CO

Question 10

6 factors that affect PVR

Answer 10

oxygen, acid-base status, pulm vasodilators (nitric or sildenafil at childrens), PPV/PEEP, lung volumes, valsalva/crying (increases intrathoracic pressures)

Question 11

explain why hyperinflation AND atelectasis both cause increased PVR

Answer 11

hyperinflation = compresses capillaries = increased PVR.
atelectasis = decreases tethering and collapses extra-alveolar vessels = increased PVR
-therefore, keep lungs recruited at FRC to keep extra-alveolar vessels tethered open, and capillaries not too compressed to minimize/decrease PVR

Question 12

most common CHF in pediatric population

Answer 12

VSD!!

Question 13

main side effect of prostaglandin E/alprostadil therapy?

Answer 13

apnea

-need to be bagged but this will increase PVR

Question 14

Epiglottitis area + degree obstruction, age, etiology, acute or delayed onset, 4 s&s, dx and cxr, tx

Answer 14

Complete obstruction of upper airway, affects epiglottis “cherry red”; 2-6 y.o. And adults affected; H influenzae B + group a strep; acute onset no prodrome period and not seasonal; signs/sx: stridor, dysphagia, drooling, distress, no cough, muffled voice, tripoding; dx hx and clinical presentation adequate, thumb sign cxr; tx: secure airway awake intubation with lidocaine, oxygen, IV abx and CS

Question 15

Eqn PEDIATRIC ETT sizing, sxn catheter sizing

Answer 15

Cuffed= (age/4)+3.5
Uncuffed= (age/4)+4
Sxn: IDD X 2

Question 16

Consequences of VSD

Answer 16

Right ventricular hypertrophY SECONDARY to pulmonary vascular remodelling resulting in high PVR
+ can deteriorate faster than ASD due to direct flow into pulmonary system leading to increased volume into LV leading to LV hypertrophY and CHF

Major difference between ASD and VSD:
VSD = LV hype trophy bc of increased blood volume back; ASD= RV hypertrophY due to vascular remodelling but happens slower

Question 17

Most common pediatric vs neonatal CHDs

Answer 17

Peds: VSD
neonates: PDA

Question 18

What is eisenmenger’s syndrome

Answer 18

Reversal of a VSD shunt = instead of left to right shunt it becomes R to L shunt due to PVR > SVR

Question 19

Name of the space between RV and the PA (RVOT)

Answer 19

Infudibulum (mal development can lead to VSD)

Question 20

Genetic defect associated with AVSD + post-repair concerns for these pts

Answer 20

Trisomy 21 And pulm htn due to shared blood flow;

Post op pts are at risk of pulm htn due to RV becoming so strong even after repair which can cause mitral valve stenosis/insufficiency. Provide O2 to these pts to reducs pulm htn

Question 21

What CHD repaired via Ross procedure?

Answer 21

Aortic stenosis:
Pulmonary autograft where pulm valve replaces the stenotic aortic valve, then human donor pulm valve replaces the pts pulm valve
Benefits: anti coagulation therapy not necessary, low regurgitation and dysfunction, valve grows with the patient, same life expectancy as general population

Question 22

What needs to be done for HLHS pt with no ASD?

Answer 22

No ASD means no way for oxygenated blood to get to systemic circulation therefore emergency cath lab for BAS= balloon atrial septostomy