Peds week 4 Flashcards by John Meyers

All neonates plus infants who are small for gestational age have a __ skin‐surface area compared to body mass ratio and __ thermal conductance d/t thin layer of subcutaneous fat

large

increased

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__ is greater in infants as a result of reduced keratin content in the infant’s skin.

evaporative heat loss

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because infants have reduced ability to generate heat, they are more prone to __

hypothermia

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Protective mechanisms such as vasoconstriction of peripheral vessels
slows heat loss from our bodies but ___

This thermoregulatory mechanism is
disrupted under anesthesia, specifically
since volatile and regional anesthetics
cause vasodilation and therefore greater
blood flow to the surface of our bodies

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The initial, rapid decrease in core temperature DURING THE FIRST HOUR OF general anesthesia is due to __

core-to-peripheral redistribution of heat

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__ and __ contribute to the most perioperative heat loss

radiation and convection

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Radiation is the transfer of energy between 2 objects that are ___

not in direct contact, and have different temperatures

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Excluding the first hour, __ is the most significant mechanism of heat loss

radiation

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Our __ lose the greatest amount of heat due

heads

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How to prevent radiation heat loss?

Increase the room temp and cover the head

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__ is the process of creating air currents by heat

Convection

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What percent of heat loss is due to radiation and convection?

radiation = 40%
convection = 30%

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Patients who are sweating 
as well as patients who have 
areas of their bodies 
surgically prepped with 
liquids (e.g., isopropyl 
alcohol, povidone‐iodine, 
and chlorhexidine 
gluconate) experience heat 
loss by

evaporation

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Which route does a BURN patient lose the greatest amount of heat?

Evaporation

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__ is the transfer of heat by physically
touching a less warm object. Where two
objects are in direct contact, heat exchange
occurs from high concentration to lower
concentration

Conduction

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Infants rely primarily on __ to generate heat.

non‐shivering thermogenesis

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rown adipose tissue is located

in __

scapulae, axillae, mediastinum,
and around kidneys/adrenal
glands

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Brown fat is highly vascularized and richly innervated
with sympathetic nerve fibers. The brown color is
caused by the abundance of __ which are
able to uncouple oxidative phosphorylation,
resulting in heat production

mitochondria

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Nonshivering thermogenesis is possible within hours
after birth and may persist up to the age of 2 years.
However, nonshivering thermogenesis is reduced in
infants anesthetized with __

inhalational agents,

propofol or fentanyl

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During anesthesia the normal thermoregulatory response of
the infant to cold stress is lost. Normal thermoregulatory skin
vasoconstriction is inhibited. There is also a redistribution of
body heat away from the central core to the periphery.

old stress and hypothermia also affects recovery from
anesthetic and relaxant drugs, impairs coagulation, may
depress ventilation, may result in dysrhythmias, and increases
post‐op O2
consumption

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What controls non-shivering thermogenesis in infants?

autonomic nervous system

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Premature infants may require ambient temp of __ to maintain normothermia

26 Celsius = 79 Fahrenheit

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What is a pyrexial reaction?

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manipulation of an infected organ or blood transfusion reaction

Posterior
fontanelle
closes at age
__ months

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Anterior fontanelle closes at age __ to __ months

9-18

What is the pathogenesis of retinopathy of prematurity

variations in arterial oxygenation and exposure to bright light = use the lowest inspired oxygen concentration that provides oxygen saturations between 92% and 96% and strive to avoid significant fluctuations in oxygen saturations.

to avoid retinopathy of prematurity, avoid fio2 greater than

40%

if your patient is light and their eyeballs are rolled up, that is called

bell's phenomenon

child with symptoms of uncomplicated URI who is afebrile with clear secretions and who is otherwise healthy,

proceed

postpone elective surgery for more severe symptoms such as

mucopurulent secretions, productive cough, pyrexia >38°C (>100.4°F), or pulmonary involvement.

consider bronchospasm if__

prolonged expiration, increased airway pressure, slow upslope of ETCO 2 tracing, raised ETCO 2, and hypoxemia

how to treat bronchospasm

deepen anesthesia/analgesia, increase FiO2, increase expiratory time (1:2.5), repeat ß2 agonist, if severe (small doses of Epi 10‐20mcg iv or via ETT

cystic fibrosis is caused by

Disruption of electrolyte transport in epithelial cells

You have a CF patient. Although you should adequately reverse the patient, avoid excessive __ due to thickening of secretions

glyco

How many breaths per minute on the ventilator for the neonate?

30-50

In the neonate, chest wall compliance is __ but lung compliance is __ compared to an adult

chest wall is more compliant | lung is less compliant

Why is subglottic stenosis such a big deal for peds?

even a small amount of swelling can occlude the airway

How many alveoli in the neonate?

30 million (1/10 of an adult)

How to calculate deadspace in a child?

2-2.5 ml/kg | kind of like the propofol dose

what is a good tidal volume for a neonate?

7 ml/kg

what is appropriate minute ventilation for a neonate?

250 ml/kg/min

what is the length of infant trachea from cords to carina?

5-9 cm

at what age do pediatric laryngeal cartilages reach adult proportions?

10-12 years

What PaO2 is a good goal when ventilating a premature neonate?

60-80 mmHg

At what rate do infants consume oxygen?

7ml/kg/min (similar to tidal volume) | twice that of an adult

How to determine ETT in French?

age + 18

How slow to run vanc and gent?

vanc 1 hour | gent 1/2 hour

Children have __ protein binding but __ volume of distribution

lower binding | larger Vd

__ soluble drugs will have a larger Vd, but __ soluble drugs will have a smaller Vd

water soluble = larger | lipid soluble = smaller

volatiles in peds are quick on/ quick off due to

high alveolar ventilation in relation to FRC, more vessel-rich tissue, and lower blood-gas partition coefficients

blend air with oxygen to maintain a sat of ___

90-95%

HCG test for any female of childbearing age or

12 years +

halothane is great except for arrhythmias, reduces CO and HR, and sensitizes the myocardium

limit epi to 1.5mcg/kg

Iso is not appropriate for inhalation induction and can release __ into the breathing circuit when used with desiccated soda lime or baralyme

CO carbon monoxide

How to reset emergence delirium?

small dose of propofol, adequate narcotics during case

Infants require __ succs than adults

when to use succs

emergency intubation, when seconds count, give atropine beforehand

Peds week 4 Flashcards

(57 cards)