Pediatrics Flashcards
(70 cards)
What are the traits of Epiglottis?
Organism: bacterial (H. Influenza, streptococci, pneumococci, staphylococci)
Age: 2-6 years
Onset: < 24 hours
Region affected: Supraglottic features (epiglottis, vallecula, arytenoids)
Neck X-RAY: thumb sign
Clinical presentation: fever, tripod position and the 4 Ds ~
> drooling
> Dyspnea
> dysphonia
> dysphasia
Treatment: oxygen and urgent airway tx
> tracheal intubation
> tracheostomy
> abx
> induction with SPONTANEOUS RR
> CPAP 10-15 to prevent airway collapse
>ENT SURGEON MUST BE PRESENT
What are some traits with laryngotracheobronchitis (croup!)
Organism: viral (influenza, parainfluenza, resp syncytial virus)
Age: < 2
Onset: 24-72 hrs
Region affected: laryngeal structures BELOW vocal cords
X-RAY: steeple sign
Clinical presentation:
> low grade fever
> barking cough
> vocal hoarseness
> inspiratory stidor
> retractions
Treatment:
> oxygen
> racemic epi
> corticosteroids
> humidification
> fluids
> INTUBATION RARELY NEEDED
What is postintubation croup?
Post-intubation laryngeal edema 😆~ complication of endotracheal intubation
> more common in small children
most common cause is using an ETT that is too large
other causes: rigid bronch, multiple intubation attempts
Usually presents 30-60 mins following extubation
What are the risk factors for post-intubation laryngeal edema?
Age < 4
ETT too large
ETT cuff volume too high
Multiple intubation attempts
Prolonged intubation
Coughing
Head or neck surgery
Trisomy 21
Upper resp tract infection
How do you prevent post intubation tracheal edema?
Maintain air leak < 25 cm H20
What is the preferred tx for post-intubation laryngeal edema?
Racemic epi
What is the volume of racemic epi and volume of NS for a child weighing 0-25 kg?
Racemic epi: 0.25 mL
NS: 2.5
What is the volume of racemic epi and volume of NS for a child weighing 20-40 kg?
Racemic epi: 0.5 mL
NS: 2.5 mL
What is the volume of racemic epi and volume of NS for a child weighing > 40 kg?
Racemic epi: 0.75 mL
NS: 2.5 mL
How long should a patient with post intubation laryngeal edema (post racemic epi) be monitored?
Min of 4 hours
What is the least to most stimulating airways?
Face mask > LMA»_space;»> ETT
What are reasons to allow surgery BUT proceed with caution?
Clear rhinorrhea (runny nose)
No fever
Active
Appears happy
Clear lungs
Older child
What are reasons to CANCEL a peds surgery? (Think URI)
Purulent nasal discharge
Fever >38 / 100.4
Lethargic
Persistent cough
Poor appetite
Wheezing/rales
Child < 1 or previous preemie
How long do most clinicians wait following a resp infection of a child before proceeding?
2-4 weeks AFTER onset of symptoms
How much does use of an ETT increase the risk of bronchospasm?
10-fold!!!
What dose of decadron will reduce the risk of post-intubation croup?
0.25-0.5 mg/kg
What is the best inhaled anesthetic to reduce post-intubation croup?
Sevo. Less pungent
What is the classic triad of foreign body aspiration?
Wheezing, couch, decreased breath sounds on affected side
Which side do children most commonly aspirate on?
Right.
How does a supraglottic aspiration present?
Stridor
How does a subglottic aspiration present?
Wheezing
What is the GOLD standard to retrieve a foreign body?
Rigid Bronch
What is the best anesthetic for a child with an aspirated foreign body?
Sevo induction with spontaneous resps
> spontaneous resps should be used THROUGHOUT procedure ~ maintains laminae flow and reduces changes of distal movement of the foreign body
avoid positive pressure (push object further)
anesthesia circuit can be connected to rigid bronch ~ easy delivery of oxygen and volatile agent
may need to add TIVA d/t dilution (like a reg bronch) ~ best maintenance technique
avoid patient coughing or bucking (also moves object further)
What are the conditions with a large tongue?
Remember “Big Tongue”
B: beckwith syndrome
T: trisomy 21
