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Peds Specialty Exam > Jenna's Notes > Flashcards

Jenna's Notes Flashcards

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1
Q

What should you do if you do not hear a leak at 20-25 cm H2O?

A

the tube is too large and you need to downsize it

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2
Q

What may be a cause of lower O2 saturation in a baby?

A

prematurity (under 37 weeks( due to underdeveloped lungs

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3
Q

When are the lungs fully developed?

A

after 37 weeks

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4
Q

For how long are premature infants at risk for retinopathy of prematurity?

A

until 44 weeks post conceptual age

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5
Q

What are 2 complications of pt with Pierre Robin syndrome?

A

micrognathia

glossoptosis – tongue falls back into posterior oropharynx

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6
Q

How do you manage the airway obstruction associate with a pt with Pierre Robin syndrome within the first 4 weeks of life?

A

elective trach

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7
Q

How do you determine the appropriate tube size for a ped?

Tube depth?

A

4 + age/4

12 + age /2

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8
Q

LMA size 1 is appropriate for what weight?

LMA size 2?

LMA size 2.5?

LMA 3?

LMA size 4?

A

< 6.5 kg

6.5 - 20 kg

20 - 30 kg

30 - 70

>70

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9
Q

When should you be concerned about loose teeth?

A

6-8 y/o

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10
Q

When does obligate nasal breathing subside?

A

3-5 months

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11
Q

What is the difference in the conducting airways when compared to adults?

A

smaller and narrower trachea and mainstem bronchi

angle of rightstem bronchus is 20 degrees for adult

angle of rightstem bronchus is 30 degrees for peds

very little distance from carina to upper lobe

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12
Q

What is the principle determinant for NG tube size?

A

Pinky finger

Premature = 6 Fr

1 yr = 8 Fr

2 yr = 10 Fr

5 yr = 12 Fr

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13
Q

What is Hb for neonate?

When does physiological anemia occur?

What is the Hb for the physiologic anemic baby?

A

15-20

3 months = physiological anemia

11-12

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14
Q

What is the blood volume of a:

premi
full-term
12 month infant

A

100

90

80

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15
Q

What are normal values for a 6 month, 7kg infant

Hb
HR
SBP
RR
O2 consumption

A

Hb = 11-12

HR 120??

SBP 90

RR 30

O2 consumption 5 ml/kg

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16
Q

When does an infant need endocarditis prophylaxis?

A

dental surgery with a lot of bleeding or manipulation of gingival tissue

respiratory tract incision into mucosa

enterococcus only Gi/Gu

infected skin, muscle tissue

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17
Q

How much drug is given for endocarditis prophylaxis?

A

ampicillin 2 gram

gent 1.5 mg/kg

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18
Q

When does the ductus arteriosus close?

A

after 2-3 weeks

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19
Q

What will keep the ductus arteriosus open?

What will make it close?

A

prostaglandins

indomethacin, ibuprofen (both are NSAIDs)

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20
Q

What may cause stress to the neonate leading to hypoxemia which will promote persistence of fetal circulation?

A

hypothermia leading to increased PVR

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21
Q

What is the path of normal fetal circulation?

A

umbilical vein
placenta
bypass liver –> ductus venosus
IVC
SVC
RA with some to RV
ductus arteriosus
aorta
body
umbilical artery
back to placenta to be re-oxygenated

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22
Q

When does PVR decrease in the newborn?

What is associated with a decrease in PVR?

A

after 2-3 months

closure of patent ductus arteriosus

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23
Q

What is the most common cause of bradycardia in neonate?

A

hypoxemia

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24
Q

What preop labs are needed for a healthy child?

A

None usually

H/H for moderate blood loss

type and cross depends on surgery

ENT may want PT/PTT

need to diagnose hemophilia A before taking tonsils out, for ex.

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25
When should surgery be cancelled in child with URI?
purulent rhinitis (green/yellow fever elevated wbc with bands (infection) infiltrate in xray
26
How do intracardiac shunts affect the rate of induction?
if R --\> L shunt, takes longer A higher concentration of agent can be used to speed this up, but will take longer to be eliminated if L --\> R, about the same and has negligible effects
27
What is TAPVR?
total anomalous pulmonary venous return
28
Describe total anomalous pulmonary venous return (TAPVR)
pulmonary veins (4) attach to the left atrium normally but in TAPVR, all 4 do not in order for a person to surive, there must be as ASD to get blood from RA --\> LA --\> body
29
What is tetralogy of fallot characterized by?
**VSD**—the hole is usually large and allows oxygen-poor blood in the right ventricle to pass through, mixing with oxygen-rich blood in the left ventricle. This poorly oxygenated blood is then pumped out of the left ventricle to the rest of the body. The body gets some oxygen, but not all that it needs. This lack of oxygen in the blood causes cyanosis. **Pulmonary stenosis**—the major issue with tetralogy of Fallot is the degree of pulmonary valve stenosis, since VSD is always present. If the stenosis is mild, minimal cyanosis occurs, since blood still mostly travels to the lungs. However, if the PS is moderate to severe, a smaller amount of blood reaches the lungs, since most is shunted right-to-left through the VSD. **Overriding aorta**—the aorta, the main artery carrying blood out of the heart and into the circulatory system, exits the heart from a position overriding the right and left ventricles. (In the normal heart, the aorta exits from the left ventricle.) This is not of major importance in infants. **Right ventricular hypertrophy**— Narrowing or blockage of the pulmonaryvalve and/or muscle under the pulmonary valvecoming out of the right ventricle.This restriction to blood outflow causes an increase in right ventricular work and pressure, leading to right ventricular thickening or hypertrophy
30
How do you treat tet spells?
Leg-chest maneuver Phenylephrine Beta blockers to prevent overworking of RV Morphine to depress ventilatory drive
31
All of the following is associated with congenital abnormalities EXCEPT: TE fistula Meningomyelocele Omphalacele Gastroschisis Congenital diagphragmatic hernia
Gastroschisis
32
What surgery should be performed for the infant with OSA?
removal of T&A
33
What is the surgical treatment for otitis media? What access is needed?
placement of ear tubes, a small tube is placed in the eardrum to equalize the pressure within the ear (which increases due to presence of pus and infection) to the atm. pressure this is called a myringotomy no vascular access is needed--inhalation induction with LMA
34
What electrolyte disturbances do you expect with massive blood transfusion?
hyperkalemia with old blood --\> **acidosis **but resolves on its own due to rapid redistribution hypocalcemia due to citrate binding to free calcium --\> **hypotension, cardiac arrest, coagulopathy** hypomagnesiemia because citrate also binds to Mg --\> dysrhythmias, hypotension, prolonged QT
35
What is the protocol for albumin therapy?
0.5 - 1 g/kg around 2.5 - 12.5 gram if no adequate response after 15-30 min, repeat
36
How do you resuscitate a pt with bowel obstruction?
fluid and electrolyte replacement usually hypovolemic, acidotic and usually need fluids, blood, and bicarb
37
When is a child considered hypokalemic?
below 3.5
38
How do you replace fluid deficit in peds?
4 ml/kg for first 10 kg. 2 ml/kg for the second 10 kg. 1 ml/kg for every kg over 20 kg ## Footnote NPO deficit is the maintenance fluid x hours NPO Replace ½ the fluid deficit during the first hour, ¼ of the deficit + maintenance fluids in the 2nd hour and ¼ of the deficit + maintenance fluid in the 3rd hour.
39
When does pyloric stenosis generally present?
2 - 6 weeks of age
40
What is the anesthetic plan for pyloric stenosis pt?
RSI because aspiration risk! Correct fluids and metabolic imbalances first!
41
What is special about extubating the pyloric stenosis pt?
DEPRESSION OF VENTILATION used to living at an alkalotic state --\> bradypnea
42
What is the cause of GI obstruction in children?
Intussusceptum (like a kaleidoscope), most commonly around 3 months - 6 years Incarcerated hernia volvulus necrotizing entercolitis
43
What is the most common childhood abdominal tumor?
**hydronephrosis, ****multidysplastic kidney** in neonates (hydronephrosis due to obstructtion of ureter, etc.) **neuroblastomas**, **Wilms**' **tumors**, and **lymphomas** are common in children
44
What is pulmonary atresia?
a form of heart disease that occurs from birth (congenital heart disease), in which the pulmonary valve does not form properly In pulmonary atresia, a solid sheet of tissue forms where the valve opening should be, and the valve stays closed. Because of this defect, blood from the right side of the heart cannot go to the lungs to pick up oxygen. If the person does not have a VSD, the condition is called pulmonary atresia with intact ventricular septum (PA/IVS). If the person has both problems, the condition is called pulmonary atresia with VSD. This is an extreme form of tetralogy of Fallot.
45
What is pulmonary atresia associated with oftentimes? What drug can treat it?
patent ductus arteriosus prostaglandins to close the PDA
46
What percentage of the term's body weight consists of water? premie? child?
**75%** 90% 64%
47
When does PVR equal that of adults?
2-3 months of life
48
What is IM dose of Sux?
4-6 mg/kg
49
What is the main cause of bradycardia in peds pts?
HR dependence
50
What results in cardiovascular development?
high oxygen consumption, double that of adults
51
What is oxygen consumption of ped pts?
6-7 ml/kg/min
52
What does the ductus arteriosus connect?
pulmonary arteries with the aorta
53
What does failure of closure of ductus arteriosus cause?
L --\> R shunt
54
What factors will produce reversion of fetal circulation in newborns?
High PVR or pulmonary HTN Cold stress of neonate that causes pulmonary vasoconstriction
55
What causes fetal bradycardia?
hypoxemia
56
What is the initial setting for defibrillation in children?
2 Joules/kg
57
What type of shunt increases the time for induction?
Right to left and it also takes longer to wake up
58
How much albumin should be given?
2.5 - 12.5 g or 0.5 - 1 g/kg
59
What is the limit of depletion of potassium?
3.5
60
What is the most common GI obstruction in peds? What are others?
intussusceptum malrotation incarcerated hernias necrotizing entercolitis
61
What is the most common abdominal tumor?
Wilms' tumors
62
What drug can affect SSEPs by increasing amplitude? What drug decreases amplitude?
etomidate volatile agents
63
What drug to avoid with SSEP/MEP monitoring?
etomidate
64
What LAs can be used in caudals?
ropivicaine bupi relief for 4-6 hrs
65
How much LA 0.25% bupi is given in a caudal?
1 ml/kg
66
How much bupi for a lumbosacral block in a caudal?
0.5 ml/kg
67
How much bupi for a thoraco-lumbar caudal block?
1 ml/kg
68
How much bupi for a mid-thoracic block
1.25 ml/kg
69
What is he max dose of bupi 0.25%?
20 cc
70
What is the dose of morphine?
0.1 mg/kg
71
What is the IV, IM dose of sux for laryngospasm?
IV: 0.5 - 1 mg/kg IM: 4-6 mg/kg
72
What is the Bain circuit?
It is a semi-open coaxial version of the Bain circuit that prevents rebreathing if FGF \> 3x minute ventilation
73
What are physical attributes of the breathing circuits for children?
lack CO2 absorbent and unidirectional valves
74
What is the correct position for the precordial stethoscope?
chest or suprasternal notch
75
What is the dose of Sux IV, IM?
2-3 mg/kg IV 4-6 mg/kg IM
76
What are the less obvious reasons to avoid sux in peds?
severe bradycardia crush injuries
77
What is the propofol infusion rate for kids?
60 - 220 mcg/kg/min
78
What is EMLA cream comprised of?
prilocaine 2.5% lidocaine 2.5% need to place for at least 1 hour for 5 mm depth
79
When is MAC highest for peds?
2-3 months
80
What drugs are not safe in MH patients?
Avoid sux and volatiles
81
What should you do in peds with cardiac dysrhthmias regarding volatile agents?
perform a SLOW induction
82
What aldrete score is required before pt discharge?
\> 8
83
When should infants be admitted overnight for procedures?
until 52 weeks post-conceptual age
84
What size blade for premies?
miller 00 or miller 0
85
when does normal renal function start?
6 months
86
What is the compliance of lungs and chest wall in peds?
low lung compliance due to alveolar immaturity high chest wall compliance
87
How do you calculate CO2 production?
8\*kg^0.75
88
What is the CO2 response curve in peds?
slope increases with gestational age
89
What is the deadspace in infants?
2 ml/kg
90
What is the oxygen consumption of infants compared to adults?
6 ml/kg vs. 3 ml/kg in adults
91
How do you manage a pt with left CDH?
place chest tube on rt side
92
How do you treat a distended abdomen witth TEF?
vent g tube
93
How much fluid in the first 24 hours for a burn?
4 ml/kg \* BSA burned
94
What is normal glucose for an infant?
50 40 is hypoglycemic

Peds Specialty Exam (2 decks)

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