peds week 2b Flashcards
(76 cards)
1
Q
What does NPO do to mucosa in peds?
A
sticky
2
Q
Deciduous teeth erupt at ___ months and begin shedding between ____ years
A
6 months and 6-8 years
3
Q
larynx located in ped
A
c3-4
4
Q
adult larynx located
A
c4-5
5
Q
shape of ped airway
A
funnel
6
Q
length of trachea(vocal cords to carina) in neonates and children up to one year of age
A
5-9cm or 2-2.5 inches
7
Q
____ to ____ cm H2O should leak
A
15-25
8
Q
is the hyoepiglotic ligament formed in peds?
A
No, so cannot compress with mac blade to move epiglottis
9
Q
Infants are obligate nasal breathers until how many months? and why?
A
3-5months because the major source of resistance to airflow is the lower airways
10
Q
overcoming the resistance of the nares accounts for ___% of the work of breathing for infants as compared to ___% in adults
A
25%, 60%
11
Q
children less than 6 months rely on what type of breathing primarily?
A
diaphragmatic breathing.
12
Q
diaphragm contains smaller percentage of what type of muscle fibers?
A
Type 1, (slow twitch, fatigues resistant)
13
Q
what age does ribe cage contribution increase to 50%
A
9 months
14
Q
What age does chest wall become stable and resists inward recoil of lungs?
A
12 months.
15
Q
Infant respiratory rate
A
30-50
16
Q
Infant tidal volume
A
7mL/kg
17
Q
Dead space infant
A
2-2.5mL/kg
18
Q
Infant Alveolar ventilation
A
100-150mL/kg/min
19
Q
Functional residual capacity infant
A
27-30mL/kg
20
Q
Infant oxygen consumption
A
7-9mL/kg/min
21
Q
how does anesthesia reduce FRC
A
causes peripheral airway collapse and impaired intercostal and diaphragm activity
22
Q
ETT calculation
A
(age in years + 16)/4
23
Q
At what pressure should there be an audible air leak around tube
A
15-25cmH2O
24
Q
post operative croup has been found to be caused by _______ more than any other factor
A
excessive tube size
25
Canceled cases reasons
wheezing,
green nasal drainage,
fever
26
increased risk of bronchospasm with
URI in past 2-6 weeks
27
contraction of what adductor muscles of larynx causes laryngospasm
lateral cricoarytenoids, thyroarytenoids, and cricoarytenoids
28
stimulation of what nerve causes laryngospasm
superior laryngeal nerve
29
causes of laryngospasm
inhalation of volatile agents,
excessive secretions in the airway,
presence of URI(hyper-irritable),
manipulation of the airway (intubation, extubation),
stimulation of the visceral nerve endings in the pelvis, abdomen, and thorax
30
Treatment of laryngospasm
1. remove irritating stimulus (suction),
2. remove debris from airway,
3. deepen anesthesia as appropriate,
4. 100% O2 via tight fitting face mask,
5. Sustained positive airway pressure (30-40cmH2O),
6. manual forward displacement of mandible,
7. if airway maneuvers fail-atropine, succs, and consider intubation
31
atropine and succs dose for laryngospasm
Succs- 0.4mgkg IV and 4mg/kg IM
| Atropine 20mcg/kg IM/IV
32
Age greatest incidence of post intubation laryngeal edema
ages 1-4
33
causes of post intubation laryngeal edema
mechanical trauma to the airway during intubation,
| placement of a tube that produces a tight fit (no leak up to 40cm H2O)
34
treatment of post intubation laryngeal edema
1. humidification of inspired gases,
2. aerosolized racemic epi 0.5mL of 2.25% solution in 2-3mL saline- vasoconstriction of capillaires in subglottic mucosa,
3. re-intubation
4. tracheostomy
35
etiology of epiglottitis
haemophilus influenzae type B
36
age epiglottitis occurs
3-6 years
37
pathology of epiglottitis
systemic septicemic process with local eythema and edema most marked in the epiglottis, aryepiglottic folds, and supraglottic connective tissue
38
symptoms of epiglottitis
rapid clinical progression of symptoms <24hrs,
| dysphgia, dysphonia, drooling, inspirtory stridor, distress, high fever >39C
39
treatment epiglottitis
```
O2,
urgent intubation of the trachea under general-NEED to be in the OR(ENT present),
Antibiotics,
antipyretics,
fluids
```
40
anesthetic management epiglottitis
do nothing to upset or agitate child,
smooth controlled induction with sevo, CPAP applied to circuit,
obtain Iv access and give atropine,
achieve stage III, do not precipitate laryngospasm, size and a half smaller ETT,
MAINTAIN SPONT VENT, direct laryngoscopy by ENT to confirm diagnosis
41
epiglottitis anesthetic implications
slow induction d/t partially obstructed airway,
inflammation of airway may enhance irritability increasing potential for coughing, breathholding, and laryngospasm.
CV depressant effects of inhale agent magnified r/t hypovolemia.
42
what accounts for 90% of infectious airway obstruction in children?
laryngotracheobronchitis (croup, subglottic infection)
43
etiology of laryngotracheobronchitis
parainfluenzae virus type 1 and 2, influenzae A, respiratory syncytial virus
44
Pathology of laryngotracheobronchitis and children age
mucosal and submucosal edema within the cricoid ring (decreased luminal size) age <2 years
45
Onset of larygotracheobronchitis
gradual onset of symptoms 24-72 hours. hx of URI progressing to hoarse cry or barking cough, low grade fever <39
46
treatment of croup
1. O2 w/ cool aqueus mist,
2. Recemic epi (vasoconstriction of capillaries in subglottic mucosa, Beta adrenergic bronchodilatory effect) Albuterol,
3. Corticosteroids? Stabilize cell membrane integrity, decrease release of inflammatory mediators,
4. antipyretics
5. intubation of the trachea is RARE unless exhaustion occurs
47
Most frequent site of foreign body aspiration
right mainstem
48
Levels of airway obstruction
distal airway, mainstem bronchus, trachea, larynx
49
S/S of foreign body aspiration
cough, wheezing, decreased air entry into affected lung, URI, pneumonia
50
Treatment of foreign body aspiration
laryngoscopic or endoscopic removal,
best to remove within 24 hr,
risks of leaving foreign object-> migration of aspirated material, pneumonia, residual pulmonary disease
51
anesthetic management foreign body
with airway obstruction- inhalation of volatile agent in O2 maintaining spontaneous ventilation,
without airway obstruction- IV induction with standard agents
52
What do you want to avoid with airway obstruction?
NDNMBs,
positive pressure may migrate aspiration material,
narrow bronchoscope creates high resistance to gas flow,
typically there is a large gas leak around the bronchoscope
53
what may be required if removal of aspirate object is too large to pass through moving cords?
succs, cisatracurium
54
post op of removal of foreign body
racemic epic, corticosteroids to reduce subglottic edema, pt may or may not be intubated
55
foreign body aspiration complications
```
airway obstruction,
fragmentation of foreign body,
arterial hypoxemia,
hypercarbia,
subglottic edema from trauma to the tracheobronchial tree - foreign body, instrumentation
```
56
tonsillectomy and adenoidectomy clinical implications
upper airway obstruction,
massive hypertrophy,
chronic upper resp infections,
OSA
57
anesthetic management T and A
premed oral or intranasal versed,
IH induction with sevo,
intubate-deep (sevo and propofol 1-2mg/kg) or with short acting NDNMB,
analgesia-MSO4 0.1mg/kg or fentanyl 1-2mcg/kg (OSA cut meds to 1/2 dose),
Steroid-dexamethasone 0.3-1mg/kg,
emergence-extubate when child fully awake,
58
post-tonsillectomy occurence
bleeding after surgery requiring surgical intervention (packing or suturing),
early-incidence 0.2-2%, withing 24 hrs 99% within 6 hrs.
Delayed- 0.1-3% incidence, 24 hrs up to 2-3 wks, peak-day 7
59
post-tonsillectomy bleeding risk
```
older pts,
presence of inflammation, infection,
preop ingestion of ASA, NSAIDS-inhibit plt function,
coagulopathy,
pts that have had strep multiple times,
using nsaids post op
```
60
disturbance of hemostasis
thrombocytopathies- nsaids, van willebrands, factor deficiencies, increased fibrinolysis
61
prevention of post tonsillectomy bleeding
```
careful dissection in tonsilar capsule,
meticulous hemostasis,
avoid surgery during/immediately after acute inflammation, infection,
avoid blind vigorous suctioning,
avoid use NSAIDS
```
62
Sign of post op tonsil bleed
frequent swallowing and throw up blood
63
tonsil bleed intubation RSI?
YES
64
clinical presentation post tonsillectomy bleeding
```
hypovolemia,
anemia,
agitation,
shock,
stomach full of blood,
active bleeding (poor visualization of glottis)
```
65
Assessment of volume status
BP(orthostatic changes, HR, urine output, mucus membranes, skin turgor, sensorium),
Labs, H/H, urine specific gravity/osmolality
66
When does establishing IV acess-rehydration or transfusion must begin? for tonsil bleed
Immediately
67
anesthetic management for post tonsil bleed?
RSI,
2 suctions, 2 blades, multi-styletted cuffed ETTs, experienced assistant.
atro, prop, etomidate, ketamine, roc, succs.
68
emergence post tonsil bleed
awake with suction stomach
69
what is choanal atresia?
occlusion of one or both posterior nares
70
atresia is partially or totally bony in ___% of cases
90
71
choanal atresia has frequent association with
craniosynostosis
72
neonates are obligatory nose breathers, bilateral choanal atresia causes suffocation if the mouth is not kept open
oral airway or large rubber nipple secured the mouth
73
with choanal atresia what needs to happen within the first few days of life
surgical correction or tracheostomy
74
anesthetic management choanal atresia
awake intubation with oral RAE tube,
maintenance -O2,N2O,IH NDNMB may be used, opioids for analgesia,
wide awake for extubation,
75
post op choanal atresia
partial or intermittent airway obstruction may persist for some time, so the infant must be observed with appropriate monitoring until airway patency is assured.
76
if stents are placed in choanal atresia
baby will transer to ICU
