Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Sim Lab 3 > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Pediatric definitions

A

Neonate: birth to 1 month
Infant: 1 month to 1 year
Toddler: 1 year to 2 years
Young children 2 to 12 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pedi respiratory anatomy differences

6

A
  1. Larger occiput
  2. Larger tongue
  3. Narrower nasal passage
  4. larynx is more anterior and cephalad
  5. Longer epiglottis
  6. shorter neck and trachea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most narrow point in the pedi respiratory tract?

A

cricoid cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Respiratory Characteristics for Pedis

SWARRRRMIIING

A
  • Short Trachea and neck
  • Weaker diaphragm muscles
  • Anterior/Cephalad Larynx
  • Relatively longer epiglottis
  • Relatively larger head / tongue
  • Reduced lung compliance
  • Reduced FRC
  • More prominent tonsils and adenoids
  • Increased RR
  • Increased chest wall compliance
  • Increased O2 consumption 6-8 mL/kg/min
  • Narrow nasal passage
  • Greater resistance to airflow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Do pedis have an increased work of breathing?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is not fully functional in the pediatric population?

A

Hypoxic and hypercapnic ventilatory drives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pediatric cardiovascular characteristics

PHIRRN

A
  • Potential difficulty with venous and arterial cannulation
  • Heart rate dependent CO
  • Increased HR
  • Reduced BP
  • Residual fetal circulation issues
  • Non-compliant LV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are residual fetal circulation issues?

A

PFO
Patent ductus arterious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Is the myocardium more or less sensitive to depressant effects of anesthetics?

A

More

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a concern about pediatric volume changes?

A

possible without accompanying HR changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Is hypothermia or hypertherma a larger issues in the pediatric populaiton?

A

Hypothermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why is hypotherma a larger issue in pedis?

A

Larger body surface area
Thin skin
Low fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the Mosteller formula for?

A

BSA calculations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the mosteller formula?

A

The SQRT of Height x Weight / 3600

BSA = m^2, Height in cm, Weight in kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the three types of fat?

A
  • White
  • Brown
  • Beige
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is white fat?

A

Most common, around organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is brown fat?

A

Energy storage
burnt to generate heat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is beige fat?

A

Combination of white and brown fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do neonates stay warm?

A

brown fat metabolism

this process is inhbited by anesthetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Pediatric renal function

A
  • Slightly reduced
  • Normal by 6 months

Can be delayed up to 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Pediatric GI function

A

Podssible increased GERD due to pyloric stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Pediatric Hepatic function

A

Decreased phase 2 metabolism
Reduced glycogen storage leads to possible hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pediatric Drug Dosing Guide / Characteristics

WADIIF

A
  • Weight based still used secondary to familiarity
  • Adjusments based on BSA rather than mass
  • Decreased protein drug binding
  • Increased circulation times
  • Immature biotransformation pathways
  • Fluid compartment changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

5oth percentile weight formula

A

(Age x 2) + 9 = (kg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Who has more total water: Adult or neonate?

A

Neonate
(Gradually decreased with age)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What does more TBW do to drugs?

A

Increased Vd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What does an increased Vd mean for drugs?

A

More drug leaves plasma and enteres intersticial space
Higher drug dosing needed
Drug clearance is slower due to lower metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

We get a fast emergence with Sevo and Des in pediatrics, what is something we need to watch out for becuae of this?

A

Incerased post-op delirium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What does halothane do to the myocardium?

A

Sensitizes it to catecholamines, so go slow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Do pedis need a higher or lower MAC?

A

Higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Is respiratory depression more or less pronounced in pediatrics?

A

More

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Nonvolatile Anesthetics in pediatrics: Propofol

A
  • Shorter eliminaiton half-life
  • Higher plasma clearance
  • propofil infusion syndrom more comin in critically ill kids
  • Accumulates more than opiods, verses, or precedex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Nonvolatile Anesthetics in pediatrics: Opiods

A
  • More pronounced effect in neonates
  • Remi has increased clearance rate
34
Q

Nonvolatile Anesthetics in pediatrics: Versed

A

Fastest clearance of all benzos

35
Q

Nonvolatile Anesthetics in pediatrics: Precedex

A

Intranasal: 1-2 mcg/kg
Up to 0.5 mcg/kg IV (watch bradycardia)

36
Q

Paradoxycal effects: Versed

A

Can be mitigated by flumazenil or precedex

37
Q

Muscle relaxers: Non-Depole

A
  • Infants require lower doses
  • use twitch monitor
  • Roc: 1-1.5 mg/kg IM
38
Q

Muscle relaxers: Depole

A
  • Infants require larger doeses
  • Succs: 2-3 mg/kg IV
  • Succs: 4-6 mg/kg IM
  • Give atropine with Succs everytime (0.1mg/kg IV or 0.02 mg/kg IM)
39
Q

What are the more pronounced sympoms from Succs in pediatrics?

HARMMM

A
  • Hyperkalemia
  • Arrhythmias
  • Rhabdomyolysis
  • Myoglobinemia
  • Masseter spasm
  • MH
40
Q

NPO guidelines for healthy kids

A
  • Clear fluids up to 2 hours prior
  • Breast milk / formula up to 4 hours prior
  • Light meal up to 6 hours prior
41
Q

Pre-OP medications

A

Versed
Ketamine
Dexmedetomidine
Fentanyl Lollipos
Versed/Ketamine Combo

42
Q

Pre-OP Dosing: Versed alone

A

0.25 mg/kg IM
0.25-0.7 mg/kg PO (20mg MAX)

20-45 min onset

43
Q

Pre-OP Dosing: Ketamine alone

A

4-6 mg/kg IM
Give with Atropine 0.02mg/kg IM

44
Q

Pre-OP Dosing: Dexmedetomidine

A
  • 1-2 mcg/kg intranasal
45
Q

Pre-OP Dosing: : Fentanyl Lollipops

A

5-15 mcg /kg

Color coded doses

46
Q

Pre-OP Dosing: Versed/Ketamine Combo

A

Versed: 0.1-0.15 mg/kg IM
Ketamine: 2-3 mg/kg IM

47
Q

Mask induction

A

No IV, kids scared of needles
Rapid Induction Speed
N2O has no odor or irritation
Sevo least offensive (good smelling stuff is added)

48
Q

Two types of mask inductions?

A

Smooth (Normal)
Steal (aggresive child)

49
Q

Smooth mask induction

A

70/30 N2O/O2 mixture
Slowly add Sevo
~4% ET Sevo to get through stage 2
Place IV after asleep

50
Q

Steal mask Induction

A
  • Occlude mask and a slightly closed APL valve
  • High flow O2, N2O, and 8% Sevo
  • Get help holding child and place mask over face
  • If kid hold breath, great!
  • Keep maks on airway as much as possible
  • Careful of Sevo overdose
51
Q

IV cannulation after asleep: common locations

A
  • Saphenous
  • AC
  • Hand
  • Wrist
52
Q

IO access

A
  • 16 or 18g IO needle with different lenghs and bevels
  • limited to no more than 24 hours
  • avoid epiphyseal plates
53
Q

IO access contraindications

PROOF-BC

A
  • Previous IO attempts (48 hours)
  • Recent orthopedic procedure
  • Osteogenesis imperfecta
  • Osteoporossis
  • Fracture
  • Burns
  • Cellulitis / infection
54
Q

IO access locations

PDS-HD

A
  • Proximal Tibia
  • Distal Tibia
  • Sterum
  • Humerus
  • Distal Femur
55
Q

IO access: Sterum

A
  • Not apporved for pediatrics < 12yr old
  • Not great for compressions
  • 1cm caudal to sternal notch
  • Midline
56
Q

IO access: Humerus

A
  • Internally rotate humerus
  • Hand placed on abdomen
  • palpate the surgical neck and insert needle 2 cm cephalad into greater tubercle
  • 45° angle
57
Q

Bullshit Humerus IO insertion flowchart

Step 1-9

A
  1. Place patients hand over abdomen (elbow adducted and humerus internally rotated)
  2. Place your palm on patients shoulder anteriorly, should feel like a ball (push deeply in obese patients)
  3. Place ulnar aspect of one hand vertivally over axilla
  4. Place ulnar aspect of opposite hand along midline of upper arm
  5. Place thumbs together over the arm, this identifies the vertical line of insertion on the proximal humerus
  6. Palpate deeply as you go up the humerus to the surgical neck (golfball meets tee)
  7. Insertion site is on most promnent aspect of greater tubercle 1-2cm above surgical neck
  8. Clean with chloraprep, aim needle 45°, push tip through skin unti it hits bone, 5mm stil above skin, drill until pop
  9. Hold hub and pull driver off, twist stylet counter clockwise, needle firmly in bone, place stabilizing dressing over hub, attach primed tubing, aspirate
58
Q

IO access: Distal Femur

A
  • Leg straight and centered in anterior plane
  • 1 cm proximal to patella
  • 1-2 cm medially
59
Q

IO access: Proximal Tibia

A

1-2 cm inferior and medial to the tibial tuberosity
(flat of the tibia)

60
Q

IO access: Distal Tibia

A
  • 2 cm proximal to the medial malleolus
    (flat of the tibia)
61
Q

IO access: Epiphyseal plates

A

drilling into these may cause growth development issues later in life

62
Q

Endotracheal Tube Medications

NAVEL

A
  • Naloxone
  • Atropine
  • Vasopressin
  • Epi
  • Lido

2-2.5 times normal dose and dilute with 5-10 mL of N/S

63
Q

Pediatric Intubation tips

A
  • Use ramping, large occiput
  • watch for prominent tonsillar tissue
  • miller blade preferred
  • cricoid is narrow so watch out for causing trauam to it with ETT
64
Q

Pediatic tube choices: Sizing

A

No uncuffed beyond 4.0
Size: Age + 4 / 4
Depth: Age +12 / 2

65
Q

Uncuffed tube leak test

A

15-25 cm H20

66
Q

Pediatric cases: ventilator

A

Smaller reservoir bags (0.5 L)
smaller circuits for reduced dead space
older machines have inaccurate pedi volumes

67
Q

Buretrol: indications and concerns

A

Limits margin of error
caution with air bubbles in pedi cases
4:2:1 rule

68
Q

Circulating blood volumes

A
  • Preterm neonate: 100mL/kg
  • Full term neonate: 85-90mL/kg
  • Infants: 80mL/kg
69
Q

Blood transfusing dosages

A
  • Platlets: 10-15 mL/kg
  • FFP: 10-15 mL/kg
  • Cryoprecipitate: 1 unit/10 kg
70
Q

Caudal anesthesia

A
  • for below the umbilicus
  • lateral
  • prone jackknife
71
Q

Caudal anesthesia contraindications

A

Infection
coaguloapathy
anatomic abnormalities

72
Q

Caudal block: what ligament do we go through?

A

sacrococcygeal ligament

73
Q

Caudal dosing

A

2 mg/kg of 0.25% Marcaine with Epi

74
Q

Pedi laryngospasm treatment

A

PPV
jaw Thrust
Propofol
Lido 1-1.5 mg/kg
Muscle relaxer

75
Q

What is the rescue position and why do we use it?

A

Lay on side, top leg out and head back

helps with secrections

76
Q

Recovery breathing treatments

A
  • Decadron (takes longer)
  • Inhaled racemic Epi

Epi: 0.25-0.5mL of a 2.25% solution in 2.5 mL N/S

77
Q

Hypothermia issues

LIPIDIC-APP

A

Left Shift Hemoglobin-oxygen sat curve (O2 doesn’t leave)
Increased Renal dysfunction
Platelet dysfunction
Increased infection risk
Decreased drug metabolism
Increased cortisol levels
Coagulopathy
-
Arrhythmias
Protein catabolism
Poor wound healing

78
Q

Emergence Delirium: Risk Factors

SPPPEC-M

A
  • Sevo / Des
  • Preschool age
  • Pre-OP anxiety
  • Parental anxiety
  • ENT procedure
  • Child temperment
  • Male
79
Q

Emergence Delirium: Tips

A
  • Reduciton in volatile agents help
  • Precedex helps smooth wakeups
  • Single use of propofol near end of procedure
  • Parental help
80
Q

Precedex dosing for kids

A

0.2-0.5 mcg/kg

Sim Lab 3 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions