Peds (Blue stuff only) Flashcards
(55 cards)
How old is Premature?
Less than 37 weeks gestation or less than 2,500 g
How old is a Neonate?
0-1 month
How old is an infant?
1 month - 1 year
How old is a Toddler?
1 year - 3 years
How old is a Small Child?
4-6 years
How old is a Big child?
6-12 years
How old is an Adolescent?
13-18 years
What is the difference between a pediatric and adult airway?
-Cartilage isn’t calcified = easier to collapse w/loss of muscle tone
-Large tongue & occiput (difficult to achieve sniffing position)
-Larynx is higher than in adults (C2-C4 compared to C3-C6). More cephalad = difficult DL
-Epiglottis is Omega-Shaped and stiff
-Narrowest point of the airway = cricoid cartilage (adults is vc).
What are the differences in pediatric respiratory physiology?
-Airway resistance is greater due to smaller diameter
-Inc WOB
-Immature CNS: Apnea/irregular breathing patterns are normal
-Use smaller cuffs to avoid swelling/pressure (can have glottic narrowing simply because of prolonged intubation)
-Chest wall is very compliant (ribs not calcified yet)
-Alveolar compliance is low (limited O2 reserve - important during induction)
-Smaller residual lung volumes
-High risk of apnea in the preterm neonate <60 wks PCA
-Increased O2 consumption compared to adults
Infants < ____ weeks PCA should be monitored with a min of pulse ox overnight after general and neuraxial anesthesia.
-Due to high risk of apnea.
-Big concern with preemies.
< 60 weeks Post-Conceptual Age (PCA)
What type of muscle fibers are the diaphragm and intercostals in peds? Why is this important?
-They are type 2 fibers: built for short bursts of activity and fatigue rapidly.
-Don’t mature until 2 years of age
-Any factor that increases WOB leads to early fatigue of the respiratory system
What are considerations regarding a patient with Trisomy 21?
-Atlanto - occipital instability (underdeveloped ligaments - be gentle with head positioning)
-Chronic URIs (inc airway reactivity)
-Large tongue
-Small oral cavity
What are the differences with the pediatric Cardiovascular physiology?
-O2 consumption is 2x that of adults (7 mL/kg/min vs 3.5 mL/kg/min)
-CO is HR dependent (hypoxemia may precipitate bradycardia -very bad in peds)
-Vagal stimulation = marked bradycardia (can pretreat with anticholinergic like glyco or atropine)
-Increases susceptibility to myocardial depression by inhaled drugs (due to calcium channel blocking activity)
What is unique about Fetal Hemoglobin?
It has a higher affinity for O2 than adult hgb.
-Compensatory mechanism for low PaO2 in fetal circulation (fetus was getting O2 from mom via placenta)
-Fetal Hgb shifts curve to the left with a lower P50
-Increased 2,3 DPG corrects this by shifting it to the right.
-Support neonatal Hgb levels to avoid tissue hypoxia
-Levels stabilize at 2-3 months old
What are the differences with pediatric fluid/electrolyte balances?
-Larger total body water percentage (TBW is 75-80% compared to adults at 60%)
-Newborn ECF is 40% of their body weight
-Neonates are unable to conserve Na
What is the Estimated Blood Volume range for a Premature infant?
90-100 mL/kg
What is the Estimated Blood Volume range for a newborn (term)? (0 - 30 days)
80-90 mL/kg
What is the Estimated Blood Volume range for an infant? (30 days - 2 years)
75-80 mL/kg
What is the Estimated Blood Volume range for a School aged Child? (3-18 years)
75 mL/kg
What is the Estimated Blood Volume range for an Adult?
65-70 mL/kg
How do pediatrics perform thermoregulation?
-Thermoregulation is compromised because of a lack of the ability to shiver.
-They metabolize brown fat, cry, and move their extremities.
-Lose heat rapidly through conduction, radiation, and convection
What are the differences in the pediatric nervous system?
-Spinal cord ends at L3 instead of L1.
-Fontanelles are not fused (monitor for volume status)
-Blood brain barrier is incomplete.
-Myelination begins during the fetal period and extends progressively. It does not reach maturity until the age of 2-3.
What happens with peds because the BB Barrier is incomplete?
This is an important consideration in drugs that may not cross the blood brain barrier in adults, but will in pediatrics.
How many mg/kg/min of glucose does an infant require?
3-4 mg/kg/min
