Final, Pedo

Question 1

Child physiology differs from adults in these ways

Answer 1

Metabolism
Cardiovascular response
Airway anatomy

Question 2

Child emergencies most often involve what?

Answer 2

Respiratory compromise- AIRWAY!

Question 3

Child’s airway anatomy

Answer 3

Larynx is more superior and anterior and has immature cartilage
Tongue is larger, and higher in mouth
Tonsils are more prominent
Head is larger proportionally

Question 4

Oxygenation DEF

Answer 4

Transport of oxygen to metabolically active tissues

Question 5

Children ventilation

Answer 5

Children breath faster and have smaller tidal volumes - overall take in less oxygen

Question 6

Brodsky Scale

Answer 6

If tonsils are greater than half the airway, likelihood of blockage inc dramatically
Do NOT sedate with chloral hydrate or meperedine if kissing tonsils

Question 7

If have kissing tonsils, don’t sedate with these drugs!!!

Answer 7

Chloral hydrate or Meperidine

Question 8

Mallampati Scale

Answer 8

View for intubation- quality of peritonsillar tissue

Question 9

Respiratory Problems

Answer 9

Prematurity
Early Life Intubation/Apnea
Respiratory Syncitial Virus
Asthma

Question 10

Premature Birth

Answer 10

Delayed development of airway–> reduced levels of surfactant
Usually have early life intubation–> will have inc post-extubation scarring
Can have impact on muscle tone, reflex arc, laryngospasm tolerance level

Question 11

Early Life Intubation

Answer 11

Post-intubation tracheal stenosis
Hyperoxgenation - bronchopulmonary dysplasia- pulmonary scarring, chronic inflammation, rt side heart failure, subglottic stenosis

Question 12

RSV

Answer 12

Virus infecting >90% but only 2% are symptomatic

Affects up to 125k in US each year

Question 13

RSV Risk factors

Answer 13

Male
Household crowding
Daycare
Gestational age

Question 14

Most common cause of bronchiolitis and pneumonia in children

Answer 14

RSV

Question 15

RSV and oral sedation

Answer 15

Inc reactivity to airway–> resp depression

Can predispose to asthma hyper reactivity too

Question 16

Asthma

Answer 16

Affects over 6 mil children

2nd most common chronic illness

Question 17

Asthma meds

Answer 17

Controllers: B agonists and Leukotriene inhibitors
Rescue Meds: Albuterol
Steroid

Question 18

Aspiration Risk Assessment

Answer 18

Lower esophageal pressure
Floppy sphincters
Reflexes not intact
Acidity and volume of gastric contents

Question 19

Guidelines for eating drinking before Sedation

Answer 19

Good - 8 hours
Formula- 6 hrs
Breastmilk - 4 hrs
Clear liquid - 2 hrs

Question 20

N2O

Answer 20

Can be truly titrated
Can have potentiating effect with other sedatives
Can produce suppression or airway reflexes (swalloing) at 50% concentration

Question 21

Chloral Hydrate: class, dose, effects

Answer 21

Hypnotic
Dose: 20-50 mg/kg
Effects: at 20-35mg - disinhibition, giddiness, irritability, anger, somnolence?
35-50mg - no giddiness, more somnolence
Are hyperactive first 20 min, then somnolence till 90 min

Question 22

Chloral Hydrate Adverse Effects

Answer 22

Dec resp rate
inc airway blockage
inc cardiac arrythmias
inc mucosal irritation
inc vomiting
inc drug-interactive effects
NO reversal agent

Question 23

Meperidine: class, dose, effects

Answer 23

Narcotic
1-2 mg/kg
Euphoria/dysphoria
Analgesia
Mood depression
irritability
obtunded responsiveness
Takes about 20 min and last till 90

Question 24

Meperidine Adverse Effects

Answer 24

Dec resp rate
Inc myocardial depression
Inc seizures
Inc vomiting
Inc drug-interactive effects

Question 25

Midazolam: class, dose, effects

Answer 25

``` Benzodiazepine 0.2-1.0 mg/kg Mood change relaxation less reactive to stimuli QUICK onset (5 min) SHORT duration (20 min) ```

Question 26

Drugs interactions with Midazolam

Answer 26

Narcotics inc adverse effects | Antihistamine - prolong effects

Question 27

Midazolam administration

Answer 27

Oral 0.2-1.0 mg/kg oral | Intranasal - faster onset and recovery

Question 28

Midazolam adverse effects

Answer 28

Resp rate decrease Inc hiccups Inc cardiac arrest Inc interactive drug effects

Question 29

Doses and Max amounts: | Meperidine

Answer 29

1-2 mg/kg | 50 mg

Question 30

Doses and Max amounts: | Chloral Hydrate

Answer 30

20-50 mg/kg | 1 g

Question 31

Doses and Max amounts: | Hydroxyzine

Answer 31

1-2 mg/kg | 50 mg

Question 32

Doses and Max amounts: | Diazepam

Answer 32

0.25-0.5 mg/kg | 15 mg

Question 33

Doses and Max amounts: | Midazolam

Answer 33

0.3-1.0 mg/kg | 15 mg

Question 34

``` Sedation med flavors Phenergan Versed Demerol Atarax ```

Answer 34

Phenergan - lime Versed- cherry Demerol - vomit Atarax- lime

Question 35

Agents for Easy procedures

Answer 35

Midazolam

Question 36

For more difficult procedures

Answer 36

Midazolam + demerol

Question 37

For difficult and long cases agents

Answer 37

GA