Paeds Flashcards

Question

VATERYL VACTERL

Answer 1

Tracheosohageal fistula Renal - drug

Answer 2

Coartation aorta Small jaw renal

Answer 3

PS HOCM Diff intub

Answer 4

OSA Difficult PIVC Premed

Answer 5

Boney SUFE ## Footnote Stickler syndrome presents unique perioperative challenges due to **collagen defects affecting multiple systems.** Here's a mnemonic focusing on key considerations, particularly regarding volatile agents and neuromuscular blockers: **S.T.I.C.K.L.E.R. Mnemonic** **S** - **Secure airway first** - Anticipate difficult intubation due to micrognathia, cleft palate, or Pierre Robin sequence[1][2][4]. Use fiberoptic intubation if needed. **T** - **TIVA over volatiles** - Avoid volatile agents (e.g., sevoflurane) to prevent intraocular pressure (IOP) spikes[6][10]. Opt for total intravenous anesthesia (TIVA) to protect against retinal detachment[6][10]. **I** - **Intraocular pressure vigilance** - Monitor for glaucoma/retinal risks. Avoid supine positioning that increases venous pressure near the eyes[6][10]. **C** - **Collagen fragility** - Handle tissues gently during intubation (risk of airway trauma)[2][4]. Use smaller endotracheal tubes. **K** - **Keep joints stabilized** - Hypermobility and arthritis require careful positioning to prevent dislocations[1][3][5]. Pad pressure points. **L** - **Limit neuromuscular blocker doses** - Use minimal neuromuscular blockade and ensure full reversal (e.g., sugammadex) to avoid post-op weakness exacerbating joint instability[3][5]. **E** - **Evaluate for emergencies** - Pre-op retinal exam to rule of detachment[6][8]. Post-op, monitor for visual changes (sudden floaters/flashes = retinal emergency)[6]. **R** - **Respiratory caution** - Post-op airway edema risk due to micrognathia[2][4]. Extubate fully awake. --- Here's the completed table section for neuromuscular blockers in Stickler syndrome, incorporating evidence from recent ophthalmic anesthesia research and connective tissue disorder guidelines: | **Issue** | **Volatile Agents** | **Neuromuscular Blockers** | |---------------------|---------------------------|-----------------------------------| | **Risk** | ↑ IOP → retinal detachment[1][3] | Residual weakness → joint instability[2][3]Enhanced succinylcholine effect[5]PONV exacerbation[3] | | **Management** | Use TIVA (propofol)[1][3] | 1. Avoid succinylcholine (risk of prolonged blockade)[5]2. Prefer short-acting non-depolarizers (e.g., rocuronium)[3]3. Mandatory nerve stimulator monitoring[3][7]4. Full reversal with sugammadex[2][3] | **Key additions based on evidence:** - Succinylcholine contraindication due to collagen defects potentially prolonging paralysis[5] - Non-depolarizers preferred but require cautious dosing (1.2x ED95 for intubation)[3] - PONV risk increases with incomplete reversal - sugammadex shown to reduce post-op emesis by 40% vs neostigmine[3] - Airway considerations: avoid NMBAs if difficult ventilation anticipated (cleft palate variants)[7] This update reflects current strabismus anesthesia protocols and connective tissue disorder precautions[3][5][7]. Citations: [1] https://academic.oup.com/bjaed/article/8/1/5/277663 [2] https://www.orphananesthesia.eu/en/rare-diseases/published-guidelines/stickler-syndrome/298-stickler-syndrome/file.html [3] https://journals.sagepub.com/doi/10.1177/0310057X20937710 [4] https://www.ncbi.nlm.nih.gov/books/NBK576442/ [5] https://pmc.ncbi.nlm.nih.gov/articles/PMC6778961/ [6] https://mhmedical.com/content.aspx?aid=58082380 [7] https://academic.oup.com/bjaed/article/5/3/76/278691 --- Answer from Perplexity: pplx.ai/share

Answer 6

Recognition: 1. Proven infection + 2 of a) <36.5 or >38.5 b) tachy c) altered ms d) prolonged cap refill (>2s) e) immunocompromise f) hypotension Warm shock: vasodilation bounding peripheral pulse wide pp Immediate: 1) ABC 2) fluid bolus 3) DEFG - 2mL/kg 10% gluc 4) adren 0.1-0.5 microg/kg/min 5) abx: cefotaxime 50 microg/kg/min

Answer 7

Bronch Acute AW obstruction CXR - hyperinflation Induction: - 100% O2 with sevo - topical to VC - drying agent -- glyco 5microg/kg IV -- atro 10microg/kg IV FM or LMA Upper AW - maintain SV lower AW - ippv + relaxant Post op: - DEX if traumatic PRN: 1. physio 2. bronchodilator 3. abx

Answer 8

Term: 37+ Preterm: 32-37, 28-32 Ex-prem: 22-28

Answer 9

Achieve: Surgical anaesthesia for BELOW the umbilicus sacral epidural space sacral canal 1. terminal dural sac 2. cauda equina 3. filum terminale 4. venous plexus 5. epidural fat Caudal space: Define: position/palp/punc Pos: left lat Palp: triange - PSISx2 and sacral cornu - sacral hiatus between 2 cornu Location: S4 - sacral hiatus Access:

Answer 10

(74.3%) The borderline candidate should demonstrate they can differentiate b/w a benign and pathological murmur and comment on potential cardiac sequelae. Inappropriate cardiology review or investigations without consideration of a benign murmur may be marked down. Benign vs pathological 70% infant has murmur - most are innocent Innocent murmur - Still's - pulm flow - venous hum (flow in systemic great veins) continuous, disappear when supine HX (likely pathological) 1. Age - ** < 12mo ** 2. chromosome abn 3. Cardiac - 4. Resp - cough, wheeze, 5. FTT 6. Recurrent infection EX (pathological) 1. Loud/harsh murmur 2. Timing - pansystolic/diastolic vs early/ejection systolic IX *ECG Referral when 1. <1yo 2. Features of path murmur *** 7s of innocent murmur Short sweet small soft systolic small single

Answer 11

Preserve HPV Pathophys: Inc PVR —> inc PAP —> blood shunt via PDA to aorta 1. Forward flow - SVR maintain/minimuse 2. Min PVR 3. Max CO - inotropy - ensure left side goes to right side - run dilute adrenaline 4. Fluids +++ (resuscitate) —> more fluid 5. Spont vent - less PVR, short I time 6. Positioning - foot > RA (lower limb ~ 20-30% circulation) Obtain IV access + IAL +/- CVL (avoid neck and upper arm —> FEMORAL) 10-20mL/kg fluid prior induction

Answer 12

Key 1. Recent exp 2. Anticipating 3. Priorities 4. Plan pre/intra/post Anticipate CCPP 1. Comm 2. Coop 3. Postop del 4. Pain mx Priorities - ID from last exp - Calm - Low stim - safe d/c Pre Min waiting time Intra - streamline - premed - OT Postop - post op distress ?cause - FLACC score - Hyration

Answer 13

a) PIVC strategy in VA CI pt 1. Environ - parent present - calm and quiet room - distraction 2. Improve visibility - Warming - Prox tourni 3. Pharm - EMLA - Coolant - N2O - Premed - IN dexmed 4. Tech - illum - USS b) TIVA techniqie Paeds difference: 1) Larger Vd vs adult 2) Faster V2 to V1 (redis) - Paedfusor - 1-16yo, 5-61kg - Kataria - 3-16yo, 15+kg - Eleveld model captures patients from age 5 days to 85 years old and with weights between 2.5 kg and 106 kg. Manual 1. McFarlan - based on Kataria (3-11yo) - ind - 2.5mg/kg - 15/13/11/10 mg/kg/hr - dec q15 - aim Cp 3 mcg/mL 2. Steur <3yo pEEG - useful adjunct 2yo+ *Risk of - accum/delayed emergence - bac contam - metabolic phenomena (unlikely in this case) Usual TIVA consideration - IV access - disconnect/failure - Waste - Cost ## Footnote TCI Anesthesia- New and More Universal Models BD June 2022

Answer 14

Ax = challenge 1. Self report - VAS - Numeric 2. Visual - FLACC Analgesic option 1. Multimodal 2. Pharm - Simples - PO opioids - NCA - Adjuncts - ket/clon 3. Regional - Caudal - Femoral

Answer 15

CP: Spectrum of motor/sensory II of variying severity CNS/GIT/MSS/Resp/Drug issues CNS - epilepsy 50% - II GIT: - bulbar palsy - poor feeding MSK - thin skin Drugs

Answer 16

ED - Disso state - irritable, uncompromising, uncooperative, incoherent, inconsolably crying, moaning, kicking, thrashing RF Anaes 1. Short acting INH Surg 1. Around H&N - ENT/ophthal Pt 1. 2-5yo B) Mx - Prevention 1. PPF (1 mg/kg), ketamine, a2ago, fent - Pharm - PPF (1 mg/kg), dexmed (0.3mcg/kg), clonidine (1mcg/kg)

Answer 17

Pre/Intra/post Pre ** assess severity ** OSA - UAO during sleep, restless, apnoea, enuresis -** IX ** PSG --> AHI > 1 v s 5 in adult AHI > 10 = severe Intraop - sed premed BAD cuz post op apnoea - IV ind if severe OSA - Gas + ETT + throat pack + gag - Shared AW !!! - Dex - suction, awake lateral extub, Post op R - hyrdation A - simples, short acting opioids *post op apnoea* Ward - Daycase vs O/N - Admit if severe OSA, comorb, < 3yo ER 68.3% 1. Assess severity of OSA 2. shared AW, AW plan, premed bad 3. post op mon and care 4. Analgesia

Answer 18

Stridor = inspiration, extrathoracic obs ~ laryngomalacia ExLarry Exp stridor = intrathoracic ~ tracheomalacia inTRAcheo RF 1. small children 2. recent URTI 3. oversized ETT a) DDx Supra/glottic/sub 80% stridor = croup = 0.5-3yo = 2' parainfluenza b) Differentiate Hx - neonate = congen ; toddles = croup ; school = peritonsillar abscess - onset: Acute = itis - subacte = croup - chronic = subglottic stenosis Ex Body position Vitals - febrile, hypotensive - sepsis Stridor timing Ix CXR - FB radiolucent - but hyperdynamic inflation

Answer 19

PRAE - periop resp AE Pt/Anaes/Surg Pt 1. Whheze 2. URTI 2/52 3. Asthma 4. Passive smoking Anaes 1. ETT 2. LMA 3. Exp anaes 4. Inh Surg 1. AW 2. NT b) Risk reduc 1. Dec sec Mech - suction, physio Pharm - glyco, salbutamol, nasal spray, 2. AW choice 3. Monitor | COLDS - current/onset/lung dx/AW device/surgery

Answer 20

Croup = viral laryngotracheitis Laryngo = (hoarse voice) Trach/bronch = cough Cause: 1. Paraflu 1/2 2. Rhino 3. Flu A/B 4. Adeno 5. RSV Prodromal + seal bark DDx: epiglottitis, bacterial tracheitis, angioedema, FB and RP abscess ## Footnote (76%) Most candidates described the cluster of Sx/Sx that would indicate a need for ETT. Most also had a safe approach to induction of anaesthesia for intubation, and this usually involved a **cautious inhalational technique**. However, many spent too long on a general discussion at the start of their answer. Also, few candidates appreciated that the **obstruction in croup is below the level of the vocal cords**, that there is usually no problem visualising the vocal cords, and that the LMA and fibrescope are unlikely to be helpful. While a **smaller ETT** than usual would be necessary in this patient, there is unlikely to be a leak around the tube until the inflammation has resolved. Finally, the **nasal route** allows far superior fixation in children and greatly facilitates the care of the child in the PICU.

Answer 21

Def: period of hypercyanosis Pathophys: Inc O2 demand Treat: Max VR, maintain SVR Hospital: O2, fluid, SVR, beta blocker, opioid (pharm vs non pharm), max PBF *phenyl/metaraminol Mechanical:

Answer 22

1. VSD 2. Overriding of aorta - aorta lies over VSD 3. RVOTO - OT start at leaving the RV —> 4. RVH

Paeds Flashcards

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