Peds Lectures Flashcards
1
Q
Neonate: Normal Vital Signs
HR:
Systolic BP:
Diasolic BP:
A
HR: 140
Systolic BP:70-75
Diastolic BP: 40
2
Q
12 months (Infant): Normal Vital Signs
HR:
Systolic BP:
Diastolic BP:
A
HR: 120
Systolic BP: 95
Diastolic BP: 65
3
Q
3 yrs (toddler): Normal Vital Signs
HR:
Systolic BP:
Diastolic BP:
A
HR: 100
Systolic BP: 100
Diastolic BP: 70
4
Q
12 yrs (school age): Normal Vital Signs
HR:
Systolic BP:
Diastolic BP:
A
HR:120
Systolic BP: 110
Diastolic BP: 60
5
Q
Neonatal/infant normal HR
A
100-160
6
Q
You can estimate an appropriate MAP of a preterm baby by what?
A
Gestational age
○ Ex: 25 weeker should have a MAP ~ 25mmHg
7
Q
HoTN for neonates is SBP < _____ mmHg
A
60 mmHg
8
Q
What is the formula to estimate SBP for older kids?
ex. 5 yr old
A
(age X 2) + 70
(5x2) + 70 = 80
SBP of 80 is normal for a 5 year old
9
Q
HoTN for:
Term Neonates (0-28day):
Infants (1-12 mths):
Children (1-10 yrs)
Children > 10 yrs:
A
HoTN for:
Term Neonates (0-28day): < 60 mmHg
Infants (1-12 mths): < 70 mmHg
Children (1-10 yrs):
< 70 mmHg + (2x age)
Children > 10 yrs: < 90 mmHg
10
Q
Hemoglobin lvls at birth are?
A
18-20 g/dL
11
Q
neonates have what % of fetal hemoglobin?
A
about 70-90%
12
Q
Why do infants around 3-4 months experience physiological anemia
A
decreased erythropoietin activity and decreased in rate of hematopoiesis (RBC production)
13
Q
Estimated Blood Volume:
-Premature:
A
90-100 mL/kg
14
Q
Estimated Blood Volume
-Newborn (<1mnth):
A
80-90 mL/kg
15
Q
Estimated Blood Volume
-Infant –> toddler
(1month-3yrs)
A
75-80 mL/kg
16
Q
Estimated Blood Volume:
child >6yr
A
65-70 mL/kg
17
Q
Estimated Blood Volume:
adult:
A
65-70 mL/kg
18
Q
HgB F P50 is ___
Hgb P50 is ___
A
HgB F P50 is 19 mmHg
Hgb P50 is 26.5 mmHg
19
Q
Hgb F has 2 ___ chains & ___ gamma chains
A
Hgb F has 2 alpha chains & 2 gamma chains
20
Q
T or F: Hbg F can bind to 2,3-DPG
A
F it can not bind to 2,3-DPG bc it doesn’t have the beta chain
21
Q
Adult Hbg has 2 ___ chains and ___ beta chains
A
○Hgb A with 2 alpha chains & 2 beta chains
22
Q
alveolar ductal development starts around ___ wks of gestation
A
24 weeks
children born before 24 wks have a low survival chance dt immature lungs and vascular system that allows adequate gas exchange
23
Q
Neonatal aveloar surface area is ____ of the adult. the alveoli will increase in # and size until about ___ yrs old
A
1/3 surface size
& 8 yrs old
24
Q
Surfactant production & secretion begins at ___ - ___ weeks gestation
A
22-26 weeks gestation
25
What type of cells create surfactant
Type II pneumocytes
peak production occurs at 35-36 wks gestation
26
4 breathing mechanics that put newborns at a disadvantage with breathing include:
pliable chest wall
■d/t lack of muscular
development
Horizontal ribs
■Don’t provide a lot of assistance w/ chest wall expansion
■When the neonate inhales - the chest wall collapses inward and they have a paradoxical breathing pattern
Flat diaphragm :
■Less dome-shaped than the adult diaphragm
Less type 1 muscle fibers
■Type 1: Slow-twitch muscle fibers that are resistant to fatigue
■When the infant starts using the intercostal muscles when breathing, they fatigue faster
●this leads to resp.
depression/distress
27
Newborns metabolic rate and O2 consumption is __ x that of an adult
2x
28
Vm in newborns are dependent on ___?
dependent on RR not Vt
They have relatively fixed Vt 6-8mL/kg, so they cannot increat their Vt to compensate for a low Vm
29
Normal RR for a newborn is ___
40-60 BPM
30
Normal RR for a 3yr old is ___
30s
31
T or F: newborn to young children have a greater FRC
F: decreaed FRC dt changes with musculature and alveoli. Even worse under GA.
■Paired w/ increased metabolic rate & O2 consumption → they desaturate very rapidly!
■A lot less reserves than in adults
■important when ventilating/intubating children → preoxygenate & don’t take a long time to intubate
32
Premature newborns are prone to ____ ____ dt immature respiratory control center
apneic episodes
that being said, they are more likely to respond to stimuli w/ apnea, which can lead to bradycardia if not resolved quickly
33
oxygen consumption for neonate and adults
6-9 mL/kg/min neonate
3.5 mL/kg/min adult
34
larynx in children are located @ ___
C3-4 children vs adults its at C4-5
35
Trachea in children is about ___ cm vs adults it is 12 cms
5cm
36
the most narrow part of the airway/trachea in children is ____ vs adults the most narrow part is the vocal cords
cricoid cartilage
* this is why they might use a uncuffed ETT in peds
37
both bronchi take off @ __ degrees until 3 yrs old
55 degrees
adults: right 25 degrees; left 45 degrees
38
BBB is immature until when
1 yrs old
39
in neonates the conus medullaris terminates btw ___ - ___ and will end at L1 at about __ yrs old
L2-3
8 yrs old
40
The dural sac ends @ __-___ until about 6 years old
S2-S3
41
2 major fontanels are
anterior: closes @ ____
Posterior: closes @ ___
Anterior - closes @ ~2 yrs of age
Posterior - closes @ ~4 mos of age
42
What type of fluid do we commonly hang for pediatric surgeries
dextrose containing fluids for infants
43
Intracranial/intraventricular hemorrhages can be precipitated by:
○ Hypoxemia
○ Hypercarbia
○ Hyper/Hypo glycemia
○ Hypernatremia
○ Wide BP swings (HTN or HoTN)
44
GFR in infants is lower until __ - ___ months old
6-12 mths
45
fluid requirements for neonates are
150 ml/kg/day
46
glycogen stores do not reach adult levels until ___ wks old
3
47
clotting factors dont reach adult levels until about __
1 week of life
48
require Vit K to prevent bleeding: what are the vit K dependent clotting factors
II, VII, IX, X
49
CYP-450 pathways mature around ___ months old
3 months
50
CO for neonates:
CO for infants
CO for adolescents:
●CO for a neonate - 400mL/kg/min
●infant CO - 200mL/kg/min
●Adolescent CO - 100mL/kg/min
51
Infants (1-6mths) mac is ___ than the adult
higher
* 2-3 months MAC PEAKS
52
MAC for 0 days to 6 months
3.2%
53
MAC for 6 months- 12 months
2.5%
54
sevo has a ___ blood solubility, which facilitates a relatively rapid inhalation induction
decreased
55
GFR for premature infants:
GFR full term:
GFR @ 2yrs old:
○GFR premature infant: 0.55mL/kg/min
○GFR full term: 1.6mL/kg/min
○2 yr old: 2ml/kg/min
56
ED50 for loss of eyelash reflexes with Propofol:
1-6months:
1-12 yrs:
10-16 yrs:
●1-6 months old: 3 mg/kg
●1-12 years old: 1.3-1.6 mg/kg
●10-16 years old: 2.4 mg/kg
57
induction dose of ketamine for children
1-3 mg/kg dt increase clearance
can be give with our without versed, and give a anti-sialogogue
58
Etomidate dose for children
0.2-.3 mg/kg relatively unchanged for adults
59
Intranasal dose for precedex
and how long does it take to hit peak effect
1-2 mcg/kg
30-40 mins for peak effect
60
morphine dose for children
0.05-0.1 mg/kg
may need smaller doe for neonates and infacnts dt resp depressant effects
61
this medication has a black box warning for children after a tonsillectomy
codeine
unpredictable metabolism --> profound resp depression
62
dose for Fentanyl in peds
0.5-2 mg/kg
63
How is the clearance for fentanyl for preterm infants compared to older infants and children
■Clearance is reduced in preterm infants but greater than adults in older infants and children
64
there is a larger Vd with fentanyl in neonates, so the dose for neonates is
3 mcg/kg bolus (no resp depression or hypoxia)
65
remifentanil can cause
bradycardia
66
do neonates or older children clear remifentanil faster
neonates
67
Succs is highly soluble and rapidly redistributed to ECF so the dose for infants IV is ____ vs children the dose is ____
infants: 2 mg/kg
children 1 mg/kg
68
IM dose of succs
neonates and infants:
>6 mths
neonates and infants: 5 mg/kg
>6 mths 4mg/kg
69
dose for neostigmine in peds
0.05-0.07 mg/kg paired with glycopyrrolate
70
dose for edrophonium in peds
0.5-1 mg/kg paired with atropine
71
Three syndromes associated with difficult airway
-tisomy 21: atlantooccipital abnormalities, small oral cavity, macroglossia
-Treacher collins syndrome: micrognathia, small oral opening, zygnomatic hypoplasia (underdeveloped cheekbones)
-Pierre-Robin Syndrome: micrognathia, glossoptosis, cleft palate, cervical dysfuction
72
after an URI brochial hyperreactivity may persist for up to ___ wks
6+ wks
*■ Current recommendations emphasize waiting 2 weeks after resolution of symptoms prior to undergoing anesthesia
73
NPO requirements: hrs
clear liquids:
breast milk:
infant forumula, nonhuman milk, light meal
regular meal, including fatty foods:
clear liquids: 2
breast milk: 4
infant forumula, nonhuman milk, light meat: 6 hrs
regular meal, including fatty foods: 8 hrs
74
oral airway measurement is measured by
tip of the mouth to edge of the mandible
75
measurement of a nasal airway
tip of the nose to the edge of the tragus
* NPA won't help if the tongue is obstructing
76
uncuffed ETT formula for ID > 2 yrs
(age/4) + 4
77
Cuffed ETT formula for ID > 2 yrs
(age/4) + 4 then subtract 0.5
78
ETT ID for 1-2 yrs
3.5mm
79
ID for an ETT for Neonate >/= 3kg Or infant
3 mm
80
Formula for length of ETT
(age/2) + 12
or
ID of ETT x 3
81
What type of tubing help prevent fluid overload in pediatric patients
Buretrol tubing
82
how do you dilute fentanyl for ped cases
draw up 2mL of fentanyl (100mcg) + 8cc of NS to make 10 mcg/mL
83
EMERGENCY drug doses:
epinephrine
Glycopyrrolate
Succinylcholine IV and IM
atropine
epinephrine: 0.01 mg/kg
Glycopyrrolate: 0.01 mg/kg
Succinylcholine IV and IM: IV 2mg/kg; IM 4 mg/kg
atropine: 0.02 mg/kg
84
Preop meds:
versed dose PO
0.25-1 mg/kg PO
can give IV version intranasally
effect achieved with 15-20 mins
84
Preop meds:
Precedex
intranasal: 1-2 mcg/kg
85
Preop meds:
Ketamine IM
5-10 mg/kg IM
* reminder: induction dose 1-3 mcg/kg
86
With fluid replacement, you never want to give ____ mL/kg in ANY HOUR
20 mL/hr
87
Fluid replacement for 3rd space fluid loss
minimal:
Moderate:
severe:
minimal: 3-4 mL/kg/hr
Moderate: 5-6 mL/kg/hr
severe: 7-10 mL/kg/hr
88
neonates, young infants < 6 months, and critically ill, and infants < 10 kg may develop ____ with prolonged periods of fasting
hypoglycemia
use 1-2.5% dextrose-containing isotonic solutions
89
if peds patient is showing symptomatic hypoglycemia what percent dextrose/dose do you administer
IV 10% dextrose 2 mL/kg
*seizures: give 10% dextrose 4mL/kg
90
Intravascular volume formula
weight x EBV
91
EBV for premature infants
90-100 mL/kg
92
EBV for full term newborn
80-90mL/kg
93
EBV for 3 mths- 3 yrs
75-80mL/kg
94
EBV for children 3-6 yrs
70-75mL/kg
95
EBV for children >6 yrs
65-70 mL/kg
96
○ Incidence of apnea is higher in neonates & premature infants w/ Hct < ____
< 30%
97
MABL formula
[EBV x (starting Hct -Target Hct)] / starting Hct
98
Volume of PRBC formula
Volume of PRBCs = (desired Hct - current Hct) x EBV/Hct of PRBCs
99
4mL/kg of PRBCs will rasie the Hbg level by _ g/dL
1 g/dL
100
when transporting peds to PACU what circuit do you use
Jackson-rees
pulse ox, prop, emergency meds
101
Incidence of delirium is 10-80% in pedi population, what age group is at the highest risk
2-9 yrs old
102
tx of delirium: 4 things
time, prop, pain tx, alpha 2 agonist
103
is the dose for LA higher in children compared to adult?
Yes, peds have higher CSF vs adults (4mL/kg vs 2mL/kg), so a higher dose is required and often a shorter DOA
104
caudal anesthesia landmarks
sacral cornu on either side of the sacral hiatus
105
what size gauge and angle do you place a caudal anesthetic
22 g @ a 45 degree
106
when placing a caudal anesthetic you will have LOR when you puncture what membrane
sacrococcygeal membrane
then aspirate and inject LA
107
What is the typical dose of a caudal anesthetic and to what dermatome does it cover
1.2-1.4 mL/kg (T4-T6) dermatome
1 mL/kg dose for lower procedures
most providers use Ropivacaine
108
common additive for caudal anesthetic
epi 1: 200
clonidine 1-2 mcg/kg
fentanyl
109
Pediatric patients who are susceptible to post-extubation croup, we will give steroids @ what dose
can also tx with recemic epi 2.25% @ ___ mL/kg
dexamethasone: 0.5 mg/kg
rememic epi: 0.05 mL/kg
110
S/S of post extubation croup will start 30-60 mins after extubation: What are the S/S
hoarseness, barking cough, and stridor
111
Prevention of post-extubation croup:
maintain air leak < 25 cm H20
112
113
Two known syndromes that are commonly a difficult intubation dt big tongues include:
Beckwith syndrome
Trisomy 21
114
4 known syndromes that are commonly difficult to intubate dt their small/underdeveloped Mandible (* remember: Please get that chin)
Pierre Robin
Goldenhar
Trachear Collins
Cri du chat
use fiberoptic intubation
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Post op goal for this specific procedure is to keep PaO2 > 150mmHg & slowly wean to lower [O2] over 48-72 hours
Cogential Diaphragmatic Hernia (CDH) surgery
141
This diagnosis is made when a neonate does not pass meconium within the 1st few days after birth .
Imperforate anus
142
What does the acronym VACTERL stand for
○ Vertebral anomalies *
○ Anal atresia
○ Cardiovascular anomalies
○ Tracheoesophageal fistula*
○ Esophageal atresia
○ Renal and/or radial anomalies
○ Limb defects
143
These s/s are indicative to:
● Bulging anterior fontanelle
● Irritability
● Somnolence
● Vomiting
● LOC
● CV collapse
Hydrocephalus
144
can VA increase ICP and at what MAC
Yes and at 1 MAC
145
____ is a type of spina bifida
myelomeningocele
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