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Pediatrics > peds deck 13 > Flashcards

peds deck 13 Flashcards

1
Q

anesthetic considerations with hydrocephalus

A
  1. intubation technique depnds on condition - if present with vomiting and lethargy = RSI 2. avoid succinylcholine due to increased ICP 3. keep intubated with PEEP post op if preop apnea and bradycardia was present
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2
Q

causes of bradycardia intraoperatively

A
  1. younger = more susceptible 2. insufflation 3. INH agent on too long
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3
Q

tx of intraop bradycardia

A
  1. tx cause (insufflation = stop insufflation; gas on too long = turn gas down) 2. determine severity 3. glycopyrrolate 4. atropine *if < 6 months will start with atropine
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4
Q

tx for emergence delirium

A
  1. parental presence 2. distraction technique 3. precedex 4. propofol 5. physostigmine (0.5 mg/kg)
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5
Q

T/F: postop shivering is uncommon with infants and younger children

A

TRUE

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6
Q

tx of shivering?

A
  1. meperidine (most common) 2. precedex 3. zofran 4. clonidine
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7
Q

increase cause for PONV

A
  1. eye surgery 2. ear surgery 3. intraop opioids 4. fluid def
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8
Q

tx of PONV

A
  1. zofran (0.1-0.2 mg/kg) 2. promethazine (0.25-1 mg/kg) 3. decrease use of opioids, use non-opioid 4. adequate hydration
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9
Q

development of the heart in utero: primitive heart tube is present by day __________, it is contracting by day ___________, circulating by day _________, and complete by day _____________

A

15; 22; 26; 63

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10
Q

if the primitive heart tube does a levo twist (L-loop) this leads to __________________

A

abnormal heart; R ventricle on left side of heart and left ventricle on right side of heart

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11
Q

Primitive heart tube should twist in the _____________ direction for normal heart development and the ventricles to be on the appropriate side of the heart

A

right (D-loop)

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12
Q

examples of left to right shunts

A
  1. VSD 2. ASD 3. PDA 4. anomaly of coronary arteries 5. endocardial cushion defect
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13
Q

HD goals for L –> R shift

A
  1. avoid increase in SVR 2. avoid decrease in PVR
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14
Q

examples of right to left shunt

A
  1. TOF 2. eisenmeger syndrome 3. ebsteins anomaly 4. tricuspid atresia
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15
Q

HD goals with R –> L shunt

A
  1. maintain SVR 2. decrease PVR
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16
Q

L –> R shunt is known as _____________ and R–> L shunt is known as _____________

A

acyanotic; cyanotic

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17
Q

what is the sequelae of a L –> R shunt

A

increased pulmonary blood flow (overcirculation) –> pulmonary HTN –> eventual R.sided hypertrophy and eventual heart failure

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18
Q

what is the sequelae of R –> L shunt

A

decreased pulmonary blood flow –> hypoxemia –> Lsided volume overload –> LV dysfunction

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19
Q

what are the 3 types of ASD

A
  1. ostium venosum (upper) 2. ostium secundum (middle) 3. ostium primum (lower)
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20
Q

which type of ASD is the most common

A

ostium secundum (75%)

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21
Q

place in order from most common to least of the different types of ASD

A
  1. secundum (most) 2. primum (second) 3. venosum (least)
22
Q

if you have a L –> R shunt that leads to pulmonary htn and RV failure –> decreased RV compliance and shift of shunt R –> L this would be called what

A

Eisenmengers

23
Q

closure of ASD is required when pulmonary : systemic blood flow ratio is > ___________

A

1.5

24
Q

all ASDs have a R-axis deviation except for ______________

A

primum (L-axis)

25
Q

an ASD __________ cm will have large shunt with substantial HD consequences

A

0.5; 2

26
Q

S/Sx of ASD

A
  1. typically asymptomatic 2. may have split S2 3. could have Lsided 2nd ICS systolic ejection murmur 4. R-axis deviation 5. dyspnea on exertion/fatigue 6. eventual Atrial arrhythmias (a.fib, a.flutter, SVT)
27
Q

CXR with ASD

A
  1. prominant pulmonary artery 2. peripheral pulmonary artery
28
Q

ways to correct ASD

A
  1. surgical - open one atrium and patch under direct visualization 2. percutaneously w/ amplatzer septal occluder
29
Q

percutaneous closure of ASD is indicated for __________________ ASD with sufficient rim of tissue around the defect

A

secundum

30
Q

what is the most common congenital heart defect

A

VSD

31
Q

25-40% of VSD close spontaneously between ages ___________

A

10-Feb

32
Q

differnt types of VSD

A
  1. membranous portion of septum (70%) 2. muscular part of septum (20%) 3. below the Ao (5%) 4. near Mv/Tv - aka AV canal defect (5%)
33
Q

what is the most common location of VSD

A

membranous

34
Q

T/F: Eisenmengers is more common with ASD than VSD

A

false; more common with VSD

35
Q

with VSD you will have a ______________ murmur at the _____________ sternal boarder

A

holosystolic; Left

36
Q

with VSD if you have pulmonary htn develop (Eisenmenger) what s/sx would you see

A
  1. RV heave 2. holosystolic murmur would decrease and would develop mumur of pulmonary regurg (Graham Steels murmur) 3. Cyanosis/clubbing
37
Q

EKG changes with small vSD

A

none

38
Q

EKG changes with large VSD

A

signs of L atrial enlargement (unusual p-wave) and Ventricular enlargement (lg R wave in V6, V5, AvL, I)

39
Q

CXR with VSD

A
  1. “shunt vascularity” 2. marked enlargement of pulmonary artery
40
Q

T/F: VSD is more common in females than males

A

false; incidence is equal M = F

41
Q

tx for VSD

A
  1. smaller ones will spontaneously close on their own 2. medical management with glycosides, loop diuretics, and ACEI 3. device closure for certain pts 4. surgical repair
42
Q

why is surgical repair of VSD “complicated”

A

because of close proximity to the conduction system of the heart

43
Q

s/sx of PDA

A
  1. bounding peripheral pulses 2. widened pulse pressure 3. continous “machinery” murmur 4. larger defect –> fatigue, dyspnea, palpitations, LVH and pulmonary htn
44
Q

if you have a small PDA, most often pts are asymptomatic; howver, they are at increased risk for _________________

A

infective endocarditis

45
Q

tx of PDA

A
  1. surgical ligation without CPB 2. percutaneous closure via piccolo
46
Q

T/F: due to risk of infective endocarditis even small PDA should be repaired

A

TRUE

47
Q

pulmonary stenosis often co-exists with what other CHD in children

A
  1. ASD 2. VSD 3. PDA 4. TOF
48
Q

90% of pulmonary stenosis is pediatrics is __________________

A

valvular

49
Q

if pt has _________________ pulmonary stenosis you would expect narrowing of pulmonary trunk/bifurcation/peripheral branches

A

supravalvular

50
Q

what is the most common cause of aortic stenosis

A

bicuspid aortic valve

Pediatrics (15 decks)

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