Pediatrics Flashcards by Anas Hamdan

The narrowest airway area in pediatrics is ….

Glottic area

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Apgar score are 5 components …

A: Activity  (muscle tone)
P: Pulse
G: Grimas (reflex)
A: Appearance (color)
R: Respiratory effort

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Apgar score 0 points are

A: flaccid
P: Absent
G: no response
A: Blue/pale
R: absent

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Apgar scores 1 point

A: Flexion
P: <100
G: Grimace
A: pink body, blue ext
R: slow irregular

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Apgar scores 2 points

A: Active
P: > 100
G: cough/sneeze
A: pink body &amp; Ext
R: Good, crying

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newborns frequently loose a point in Apgar score due to …

Peripheral color for being blue.

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BLS in neonates with bradycardia & cynosis, difference is

starting positive pressure before chest compression

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When meconium aspiration suspected….

Intubate -> suction -> then ventilate.

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Umbilical Arterial ABG in newborn (normal values)

7.28/50(CO2)/20

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Umbilical Venous ABG in newborn (normal values)

7.35/40/30(O2)

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Umblical ABG in neoborna at 60 min

7.30 - 7.35
30 PaCO2
60 PaO2

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Which one has higher PaO2, Ductus venosis or Ductus Atreriosus

Ductus Venosis: high PaO2

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What nerve risk for damage during PDA ligation

Left Recurrent laryngeal (it arches the aorta and close to PDA)

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Fetal Thiopental concetration are low during general anesthesia for CS because

Maternal distirbution

- Metabolism by fetal liver.

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Water % of bodyweight in term vs preterm neonates

70% Term

80% Preterm

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When … the rate of the work of breathing is similar in neonates and adults

corrected for weight & metabolic rate

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O2 consumption for work of breathing in neonates is …% of total body O2 consumption

1-2%

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first step when child is breath hodling during induction is

positive pressure with 100% O2

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the best sign for reversal of NMB is …. and the best clinical sign in infants is … compared to adults …

ToF > 0.9
lifting of legs in infants
masseter muscle tone in adults, indicates >0.8 ToF (note the best sign is ToF >0.9)

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spinal anesthesia in neonates differ than adults in dose …

neonates needs larger doses due to increase in CSF volume compared to adults

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spinal anesthesia in neonates differ than adults in duration …

shorter block in neonates due to rapid turnover of CSF

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High blocks in neonates manifests as

Apnea rather than hypotenstion

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The most common indication for spinal in pediatrics is

ex-premature presenting for inguinal hernia repair

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the incidence of PDPH in children is … compared to adult

lower

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The dural puncture and total spinal is more common in neonates than adults because

the anatomy of dural sac ends lower

Dose Mg cross placenta? and whats the antidote?

Yes | Calcium

In order to prevent retinopathy of prematurity, the PaO2 should kept below

70 mmHg

BP & HR at birth vs at 1 year

Birth: 65/40, HR 140 | 1 year: 95/65, HR 120

Reason for desaturation in neonates & infants

increased metabolic rate and O2 consumption (not decreased FRC or FRC/TLC ratio)

The loss of heat is faster in neonates compared to adults because

their larger surface area-bodyweight ratio (they also have less SQ fat and therefor have less insulation for heat preservation).

Neonates heat production is dependent on

metabolism of brown fat

Refrance weight for neonates is 3 kg vs 70k in adults. what would be TV, VC, FRV and dead space differnces

TV 6 ml/kg in both VC 35 ml/kg (70ml/kg in adults) FRC 30 ml/kg (35 ml/k adults) Dead space is same 0.3xTV

When adult breathing circuit is used for infants, TV should be ... to compensate for the compliance of tubing

Increased

Would you proceed to OR if EMLA cream applied to a broken skin unintentionally on neonates?

better to postpone and observe for methemoglobenemia (ELMA is eutectic miture of lidocaine & prilocaine, pro;pcaine increase risk of methemoglobenemia)

Best option for induction in child with epiglottitis is

gental mask induction with sevoflurane + O2 100%

Parental presence benefits

reducing separation anxiety but wont prevent pr decrease postoperative delirium

fasting interval in children for clear liquid

2 hours

fasting interval in children for human milk

4 hours

fasting interval in children for non-human milk

6 hours same as light meal

Fetal Hg can falsely elevate COHb levels upto ... in first weeks of life

7-8%

RFs for postoperative apnea in premature infants are who should be admitted and monitored (and for how long) after outpatient surgery.

The most conservative approach is to admit (for monitored 24 hour observation) all infants younger than 60 weeks post-conceptual age

Why Pierre Robin is difficult airway

Glossoptosis

Why Treacher Collins is difficult airway

Micrognathia

Why Klippel-Feil is difficult airway

Cervical spine immobility

Would you proceed to OR with 1 week old African american with hx of SCD in family?

Yes, fetal Hb provides protection from sickling

when is a physiological decrease in Hb concentration in infants (physiological anemia)

at age of 3 months due to declining fetal Hb

what needs to be managed before pyloric myotomy?

fluid & electrolyte imbalance. its not an acute emergency

metabolic abnormalities seen with pyloric stenosis

hypoCl-, HypoK, HypoNa, metabolic alkalosis. (metabolic acidosis if untreated)

commonest type of Tracheoesophageal fistula is

Type C (fistula between the lower esophagus and the trachea (one form of TEF) with a blind esophagus upper pouch)

ideal ET position in TE fistula?

above carina but belo the fistula. breath sounds should be bilateral, no sounds over stomach, or no leakage of gas through gastrostomy tube

Anomalies associated with TE fistula

Vertebral, cardiac, renal, radial anomalies

MoA of agents used for pulm Htn: PGE2 NO

PGE2 -> cyclic AMP | NO -> cyclic GMP

Mgmt of Pulm Htn in CHD

- Increase FiO2 - Avoid acidosis - moderate hyperventilation - moderate hypocapnia - Avoid hypothermia - Inhaled NO - PGE2

Anesthesia Concern for Congenital diaphragmatic hernia

- Pulm hypoplasia - Pulm Htn - Risk for PTX due to high airway pressures - Bag & mask ventilation (overdistension of stomach & herniation across the midline)

Ventilator strategies in Congenital diaphragmatic hernia

- Low TV - Peak airway pressures < 25 cm - Permissive hypercarbia to achive preductal O2 Sat 90-95%

Neonatal Continental defects that associated with CHD?

- Congenital diaphragmatic hernia - Omphalocele - TE fistula

Meningomyelocele is associated with

Arnold-CHiari malformation & Hydrocephelus

Components of ToF

``` PROVe pulm stenosis RVH Overriding aorta VSD ```

preferred induction agent in ToF tetspells

Ketamine tetspells occur when PVR increases or SVR decreases (ketamine maintains or increases SVR)

TTx of Tetspells in ToF

- 100% O2 - BB - IVF - Phenylephrine to increase SVR

Anesthetics goals in ToF reair

- Maintain intravascular volume - Higher FiO2 - Maintain SVR (use Neo) - Ketamine induction (maintain SVR) - Propranpolol for infundibular spasm

Continues machinery murmur best heard at ... and its specific for ...

Left clavicle | PDA

Why neonates with PDA would have wide puls pressure

reduced diastolic pressure

PGE1 ... PDA patency

keeps it open (indomethacin closes it)

Hpoplastic left heart syndrome occurs when parts of left heart is not completely develop, thoses parts are

MV L ventricular AV and aorta blood pumped to body through RV which has to pass through PDA to reach systemic circulation

Anamoly that both pulm & systemic venis returns to RA is

Total Anamolous pulmonary return (TAPVR) ASD?VSD needed to pass from RA to left

Single vessel recives blood from both R & L ventricle and then devised into aorta & pulm artery is

Truncus Areriosus

do they need PDA in Truncus Areriosus for life?

No because mixing has already occurred

one CHD in which PDA not essential for life

Truncus Areriosus

CHD in which ODA essential for life

``` Pulm stenosis Aortic stenosis ToF Transposition of great vessels TAPVR Hypoplastic L heart syndrom ```

whats the name & indications of procedure that diverts venous blood from RA to pulmonary circulation bypassing RV

Fontan procedure - Hypoplastic L heart syndrome - Tricspid atresia with intact ventricular septum

Hypothermia or hyperthermia that increases Pulm vasoconstriction and increases R->L shunts

Hypothermia

A disorder of lung parenchyma that results into hyperinflation of lung & respiratory distress from newborns to 6 months

Congintal lobar emphysema - Avoid high peal airway pressure with ventilation - Avoid NO - Assisted ventilation is required

NMB overall dose should be reduced in neonates due to

their large volume distirbution, NMJ and liver is immature

Pediatrics Flashcards

(74 cards)