pediatric Flashcards

(45 cards)

1
Q

main take away from peds population

A

if something bad is going to happen – it happens much quicker in children so need to respond at a good time

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2
Q

main thing with GA

A

complete or partial loss of reflexes

like have to brethe for them - inability to maintain a patent airway or respond to verbal or physical stimulus

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3
Q

minimal sedation

A

respond everything basically the same

respond NORMALLY

type given before GA

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4
Q

moderate sedation

A

response purposefully to verbal commands and maintain airway

cardio and resp adequate and maintained

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5
Q

when can peds patient take the oral med for minimal

A

once arrive at the office

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6
Q

deep sedation

A

aroused with repeated verbal or painful stimulus

partial or complete loss of protective airway
- assistance to airway may be necessary

cardio function maintained !

response = purposeful to pain 
airway = +/- interventon 
ventilation= +/- inadequate 
cardio = +/- maintained
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7
Q

narrowest part in peds airway

A

cricoid ring - narrowest

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8
Q

child talking what age

A

under age of 12

- when referring to anatomics

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9
Q

large ___ in kids ?

tracheal lenght?

A

large tongue and epiglottis
enlarged adenoids and tonsils
- reach max at 6-8

short neck

anterior placed airway and is funnel shaped

narrow nasal pasasges

trachea is 4-5.5 cm
- every mm of trauma = 60% decrease in size

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10
Q

cranial vault to airway in child

A

rapid cause upper airway oobstruction

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11
Q

breathing differnces

A

children - see more abdominal movement

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12
Q

FRC in children

A

5:1

reserve is small
so get hypoxemia faster - respiratory arrest faster then bradycardia then death

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13
Q

physiological differences in children

A

higher metabolic rates
- need more oxygen

greater frequency of breathing

FRC = 5:1

smaller reserve

more suceptible to hypoxemia

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14
Q

intermittent asthmatic patient?
mild persistent
moderate persistent
severe persistent

A

symptoms no more than 2 / days a week

mild = greater than 2 days

moderate = daily

severe = throughout the day have symptoms

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15
Q
range of age 
neonates
infants
children
adolescents
A

0-30 days
1-12 months
1-12 years
13-18 years

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16
Q

Cardiac output it ___ dependent

A

rate dependent and by vagal parasympathetic tone predominates

cardiac output is 300-400 ml/kg min @ birth

200-300 ml /kg/ min - infants and children

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17
Q

blood volume in newborn
6 weeks to 2 years
2 years - puberty

A

85-90 ml/kg

85 ml/kg

80 ml/kg

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18
Q

smaller blood volume in

A

children
- rate dependent
so vasovagal attack is cardio

HR is higher

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19
Q

blood volume of adult

20
Q

HR in peds

A

naturally higher

new born is 120 average

10 years is 90

21
Q

so what would bradycardia be in a younger child

A

age dependent

less than 16 average can be 75 - 80

22
Q

how to decide technique to help with anxiey with child

A

age
level
urgency of tx
type of procedure

23
Q

typical under sedation with pedo

A

oral prophylaxis
dental restortions
dental extractions
dento alveolar sugical procedures . pathology, trauma, impaacted teeth removal

make sure airway is patent

24
Q

GA use?

A

when more severe

25
pre operative assessment
age, body weight last meal or drink? - can vomit easily medical history -- important to ask - CHD? - asthma? - bleeding disorders? recent ilnness like URI? allergies? previous exerience with anesthesia? family history? - like malignant hyperthermia
26
recent URTI?
airway narrow more likel to have upper airway obstruction faster can be contraindication
27
monitor if going to sedate?
HR, pulse oximiter SPO2, BP, Resp rate examination of head and neck - airway, size of tongue, tonsils, patency of nares, range of motion of neck, mouth opening chest exam and auscultation - shape, breath sounds, heart sounds, murmers
28
last meal - solids, and liquids 6-36 monhts over 3 years?
6-36 months greater than 6 hrs for solids, 2 hrs for liquids over 3 years 6-8 hours for solids, 2 hrs for clear liquids
29
T/F aspiration is an independent risk factor
True
30
measure a nasal laryngoscope
nose to angle of the mandible
31
airway in terms of stiff and collapsable
nasal segment - cartilage and palate pharyngeal segment -- soft portion - is collapsable tracheal segment can get pharyngeal collapse during sedation posture of patient is important - giving positive pressure - able to open up the collapsed portion
32
monitoring equipment
pre-cordial stethescope pulsoximeter BP monitor capnograph ECG
33
Local anesthesia
weight based | wait till anesthetic takes effect
34
max LA for child
7.0 mg/kg for articaine
35
anxiolytics / sedatives used in children
benzo = midazolam (most likely to use) , valium antihistamines - hydrocyzine (vistarill) sedative / hypnotics - chloral hydrate narcotics - fentanyl, meperidine
36
N20 use
inhalation - good one to use with children dissociates quickly
37
enteric
goes through GI ora, rectal, intranasal
38
parenteral
IM and IV
39
dose of midazolam in child
.25 -.5 mg/kg PO or .2 to .3 mg/kg IV better amnesia than valium** can be reversed with flumazenil water soluble -- makes it not as painful on injection
40
opioid use in pediatric sedation
pediatric mortality and morbidity incresed when opiates + other sedatives used
41
snoring indicates
hypopharngeal obstruction
42
stridor means
laryngospasm
43
what is a sign of hypoxeia
bradycardia
44
what is a sign of hypoxeia
bradycardia
45
biggest emergency when sedating patietn
emesis, and aspiration