ICU/Lines

Question 1

Umbilical Catheters. Where should the tip be placed?

Answer 1

Vein: IVC/RA junction - at the level of the diaphragm (T8-10)

Question 2

Contraindications to umbilical catheters?

Answer 2

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Question 3

Short and long term complications of umbilical catheters?

Answer 3

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Question 4

Central access complications. Ports - common problems and fixes?

Answer 4

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Question 5

Broviac/Hickman. Common problems and fixes?

Answer 5

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Question 6

ASA classes?

Answer 6

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Question 7

Describe revers ratio ventilation?

Answer 7

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Question 8

Indications for reverse ratio ventilation?

Answer 8

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Question 9

Physiology of reverse ratio ventilation?

Answer 9

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Question 11

Explain mechanisms of gas exchange with ventilation, highlight HFO?

Answer 11

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Question 12

What parameters can be modified with HFO?

Answer 12

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Question 13

Antibiotic prophylaxis for cardiac patients? Who? When? Why?

Answer 13

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Question 13

How do you adjust for high PaCO2 and low PaO2?

Answer 13

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Question 14

What causes HUS?

Answer 14

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Question 15

What are the complications of HUS?

Answer 15

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Question 16

Hemolytic disease of the newborn.

Answer 16

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Question 17

Indications for ECMO?

Answer 17

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Question 18

Contraindications to ECMO?

Answer 18

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Question 19

Compare/Contrast VV and VA ECMO?

Answer 19

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Question 20

Complications of ECMO. Patient factors and Circuit factors?

Answer 20

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Question 21

Meconium aspiration - describe physiology of the VQ mismatch?

List non-ECMO treatments?

Answer 21

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Question 22

Calculate oxygenation index (OI)?

Answer 22

OI=MAP x FiO2 x PaO2/100

Question 23

Define SGA?

Answer 23

Under 10 percentile for weight at given gestational age.

Question 24

What are the cutoffs for LBW/VLBW/ELBW?

Answer 24

2500 g
1000 - 1500 g
< 1000 g

Question 25

Mechanisms and challenges of Acid base balance in the neonate?

Answer 25

Carbonic acid-Bicarb buffer. Respiratory compensation - immediate for repisratory/CO2 disturbances, Delayed for metabolic/HCO3 disturbances. - impaired with prem lungs/CLD Renal compensation - regulates H+/HCO3 excretion. Mostly occurs in proximal tubules. - impaired by low GFR in firs 24-72 hours of life, - Maturation of tubular function also takes time and the ability to reabsorb bicarbonate does not reach adult levels until one yr of age. Most sever in prems.

Question 26

IVH mechanism:

Answer 26

Rarely occurs beyond 32 weeks. Gelatinous germinal matrix provides little support for capillaries. The subependymal germinal matrix easily bleeds extending into the ventricles. Periventricular leukomalacia develops from necrosis of adjacent white matter. Decreased ability to regulate cerebral blood flow places prems at risk.

Question 27

Mechanism of hydrocephalus with IVH?

Answer 27

Blood in the ventricles leads to arachnoiditis and impaired CSF flow at the Sylvain aqueduct.

Question 28

Risk factors for IVH?

Answer 28

``` Lower gestational age Lower birth weight Male/white APGAR , 3 at 5 min Chorioamnionitis Cardiac resuscitation RDS CO2 disturbances HFO PDA ```

Question 29

Factors to decrease the risk of IVH?

Answer 29

- Antenatal steroids (2 doses given within a week of delivery and 12 hours prior to delivery) - Avoid rapid volume expansion with resuc - correct coags - avoid hypoxia/hypercarbia

Question 30

Diagnosis of IVH?

Answer 30

Physical signs: bulging fontanelle, Seizure Labs: low HCT, hypotension, hyperglycemia, metabolic acidosis Ultrasound/MRI

Question 31

IVH Grading:

Answer 31

Grade 1 - confined to germinal matrix Grade 2 - IVH without dilated ventricles Grade 3 - IVH with dilation Grade 4 - IVH with periventricular hemorrhagic infarction

Question 32

IVH management:

Answer 32

Supportive care - maintain blood pressure and appropriate HCT. Control Seizures. Monitor with Weekly U/S to monitor hydrocephalus

Question 33

Mechanisms of heat creation in neonates?

Answer 33

Increase metabolic rate through non-shivering thermogenesis I.e. utilization of brown fat.

Question 34

Mechanisms/risks of heat loss in neonates?

Answer 34

1) Increased surface area to mass 2) Immature skin and low fat content increase evaporative loss 3) Limited stores of fat and glycogen to increase metabolism 4) Impaired shivering response 5) Inability to communicate

Question 35

Mechanisms of heat loss in the OR?

Answer 35

- exposure of viscera to low ambient temperatures - IV solutions - Irrigation solutions - impaired CNS/muscular thermoregulation from medications - Ventilatory heat loss

Question 36

Bilirubin metabolism from Heme to conjugated Bili:

Answer 36

RBC break down->Heme (heme oxygenase) -> biliverdin (biliverdin reductase) ->unconjugated bilirubin bound to albumin - at high concentrations crosses BBB. Bili bound to albumin is conjugated in the liver and excreted into bowel where it has two fates - excretion or conversion to unconjugated by b-glucuronidase and reuptake.

Question 37

Mechanism of physiologic jaundice?

Answer 37

Immature hepatic conjugation leads to accumulation over the first week of life usually peaking at 48-72 hours and then resolving over the next 5 days.

Question 38

Causes of pathological jaundice in the neonate?

Answer 38

1) increased Bili production 2) Decreased clearance 3) Breast feeding jaundice

Question 39

Causes of increased Bili production in the neonate:

Answer 39

1) increased Bili production: - Hemolytic disease of the newborn -> autoimmune, inherited red cell membrane defects, enzyme deficiencies, and hemoglobinopathies. - sepsis/DIC - blood loss/hematoma from birth trauma - polycythemia

Question 40

Causes of decreased Bili clearance in the neonate:

Answer 40

- bowel dismotility - prematurity - metabolic derangement - bowel obstruction or Ileus

Question 41

Breast feeding Jaundice vs breast milk jaundice?

Answer 41

Breast feeding: decreased caloric and fluid intake, possible increased intestinal reabsorption - treat with increasing the frequency of breast feeding to 8-12/day. Adequacy is measured by 4-6 wet diapers/day and 3-4 stools/day with transition to seedy at day 4. Breast milk jaundice: peaks at 2-3 weeks. Deconjugating enzymes in breast milk (unproven)