Term
Pediatric CO is dependent on? |
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Definition
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Term
what is different about infant respiratory muscles |
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Definition
they have less Type I muscle fibers which are high oxidative. So they fatigue easily
Slow twitch fibers are referred to as "slow twitch oxidative". Type I fibers are characterized by low force/power/speed production and high endurance, |
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Term
having less type I high oxidative resp muscle fibers predisposes the infant to |
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Definition
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Term
when you're listening to your pedi airway and has ETT they should have an audible leak at what ___cm H20 |
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Definition
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Term
Without an audible leak on the ETT the pediatric is 10x more likely to develop what post extubation |
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Definition
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Term
what is the capillary bed perfusion pressure? Why is this important in the child's airway and how does this relate to the cuff pressure |
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Definition
capillary bed pressure is 25 mmHg. So if you don't have an audible leak at 16 cm of H20 then your tube is too big or cuff inflated too much. |
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Term
which child age group are obligate nose breathers |
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Definition
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Term
when do pediatrics undergo airway changes? |
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Definition
at puberty due to hormones |
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Term
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Definition
when tissue obstructs the nares. This is very dangerous because infants are obligate nose breathers |
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Term
list risk factors for post extubation croup |
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Definition
1. polonged surgery 2. repeated ETT attempts 3. large ETT 4. head/neck surgery 5. increase ETT movement |
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Term
what is the treatment for post-op croup |
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Definition
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Term
why is stroke volume fixed in infant |
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Definition
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Term
why are babies/infants known as vagal animals |
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Definition
b/c their pns is fully developed at birth but their SNS is not so PNS > SNS |
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Term
How long does it take for the SNS to develop |
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Definition
develops during first 6 weeks of life/. Therefore new borns have a poor ability to adapt to changing pressures. Also their baroreceptors are not fully developed. |
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Term
why are infants more likely to devleop jaundice |
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Definition
b/c they have immature livers which are not good at conjugation reactions. So if RBC are destroyed at higher rates they can't keep up and the baby becomes orange color. |
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Term
increase bilirubin levels will result in what condition in infants and can also caused what |
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Definition
increases bilirubine will lead to kernicterus and cause retardation |
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Term
how do you treat kernicterus |
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Definition
photoherapy/hydration, if extreme then exchange transfusions |
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Term
the first fontanel to close are |
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Definition
posterior and anterolateral close within 2 months |
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Term
the last fontanel to close is |
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Definition
posterolateral at 2 years |
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Term
hematopoieses occurs where in the newborn then switches when |
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Definition
occurs in the liver initially and switches to bone marrow by 6 weeks. |
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Term
What is a physiolhttp://www.flashcardmachine.com/my-flashcards/quick-editor.cgi#ogic nadir |
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Definition
Describes the switch in Hb from fetal to adult version by 4-6 months. Is associated with a transient decrease in Hb levels. |
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Term
what is the EBV of a premie |
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Definition
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Term
what is the EBV for a full term infant (<1y/o) |
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Definition
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Term
what is the EBV for a child before puberty |
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Definition
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Term
why does a new born have such a high HCT |
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Definition
because they need a high HCT to offset the tendancy of the fetal Hb to left shift and hold onto O2. Which means less for tissues. And now that they don't have placental supply they have higher O2 demands cause they need to make it themselves. So left shift not ideal. They need to get by until nadir physiological shift occurs. |
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Term
hematopoieses occurs where in the newborn then switches when |
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Definition
occurs in the liver initially and switches to bone marrow by 6 weeks. |
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Term
What is a physiologic nadir |
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Definition
Describes the switch in Hb from fetal to adult version by 4-6 months. Is associated with a transient decrease in Hb levels. |
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Term
what is the EBV of a premie |
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Definition
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Term
what is the EBV for a full term infant (<1y/o) |
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Definition
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Term
what is the EBV for a child before puberty |
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Definition
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Term
why does a new born have such a high HCT |
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Definition
because they need a high HCT to offset the tendancy of the fetal Hb to left shift and hold onto O2. Which means less for tissues. And now that they don't have placental supply they have higher O2 demands cause they need to make it themselves. So left shift not ideal. They need to get by until nadir physiological shift occurs. |
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Term
why are neonates resistant to sux effects |
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Definition
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Term
what local is not well metabolized by the pediatric population |
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Definition
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Term
what kind of delierum is common in pedi |
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Definition
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Term
what kind of shunt has little effect on inhalation induction time |
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Definition
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Term
What kind of shunt has significant delays on IV induction |
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Definition
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Term
what kind of shunt has a large effect and delay on inhalation induction medications |
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Definition
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Term
what characteristics of a pediatric patient makes them more at risk for hypothermia intraoperative |
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Definition
1. large BSA 2. little SUB Q fat 3. Inability to shiver 4. Immature hypothalamic temperature regulation |
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Term
how doe infants ect produce heat if they can't shiver |
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Definition
thermogenesis via brown fat reserve breakdown |
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Term
what happens to the circulatory system if baby is very hypothermic |
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Definition
baby will return to a fetal circulation due to acidosis or high SVR. Remember baby will increase CO for thermogenesis from 10% of CO to 75%. That means less O2 and CO for other areas of the body. Therefore lactic acidosis and anaerobic metabolism begins. |
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Term
what percentage of CO goes to thermogenesis of brown fat during 1. normothermia 2. hypothermia |
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Definition
1. Normothermia: 10% of CO 2. Hypothermia: 75% of CO |
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Term
hypothermia results in these pathological changes to the newborn/pedi |
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Definition
1. INCREASE O2 consupmption 2. hypercapnia 3. hypoxia 4. acidosis 5. hypoglycemia = Increase pulmonary resistance and R-L shunt |
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Term
The eventualy cardiac/pulmonary change in the pedi form hypothermia is what kind of shunt |
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Definition
Right to left shunt due to vasoconstriction of pulmonary and systemic But also increase hypoxic constriction of pulmonary due to high metabolism needs of thermogenesis and dilution of O2 by excess CO2 byproducts. |
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Term
the biggest concern for a pedi patient with a URI is |
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Definition
bronchospasticity 1. larygnospasms 2. croup |
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Term
hyperactivity after a URI in a pedi patient can linger for how long after is subsides |
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Definition
hyperactivity remains 2-4 weeks after pulmonary changes remain 4-7 weeks after |
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Term
To diagnose a URI pt must have 2x of the following: |
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Definition
1. sore/scratchy throat 2. sneezing 3. rhinorrhea 4. congestion 5. malaise 6. non-productive cough 7. temp > 38.5 8. laryngitis |
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Term
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Definition
1. onset 2. active 3. resolution |
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Term
the kid last drank orange juice with pulp. how long must they wiat until surgery |
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Definition
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Term
is aspiration common in the pedi population |
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Definition
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Term
how long must kid wait if breast milk was last taken |
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Definition
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Term
neonates glycogen stores are ___ to adults |
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Definition
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Term
list pediatric patients who are prone to hypoglycemia |
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Definition
1. premature infants 2. neonates 3. infants of diabetic mothers 4. IUGR intrauterine growth restricted / SGA small for gestation age 5. Chronically ill infants/children 6. Extensive preop fasting |
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Term
most common cause for a surgical emergency in the pedi population is from |
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Definition
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Term
Name 6x surgical emergencies |
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Definition
1. trache-esophageal fistual 2. ophalocele 3. gastroschisis 4. pyloric stenosis 5. congenital diaphragmatic hernia 6. necrotizing enterocolitis 7. Foreign body aspiration |
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Term
most common type of tracheoesophageal fistual is; describe it |
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Definition
Type IIIB: Characteristics as followed:
1. upper esophageal atresia with no communication to trachea. So esophagus from mouth goes to a dead end.
2. But the distal esophagus from the stomach communicates to trachea slightly above the carina (90%) |
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Term
what anesthesia considerations will you need to know for type IIIB tracheo-esophageal fisula case |
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Definition
the communication of the esophagus is with its lower segment attached to the stomach and communicating just above the carina. So place ETT so that the tube is past the fistual but above the carina. * Expect lg amt of secretions *No + pressure ventilation * Awake intubation |
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Term
Tracheo-esophageal fistula has what sx. Most common complication? |
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Definition
1. coughing / choking 2. gastric distension with respirations 3. aspiration PNA ** 4. pulmonary complications ** 5. large amount of oral secretions |
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Term
is gastroschisis or omphaolocele more common |
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Definition
omphalocele more common 1:5000 births while gastrochisis is 1:15,000 births |
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Term
is gastroschisis or omphaolocele associated with cardiac abnormalities |
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Definition
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Term
What does VACTERL syndrome stand for |
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Definition
VACTERL Syndrome The VACTERL association (also VATER association) refers to the non-random co-occurrence of birth defects The reason it is called an association, rather than a syndrome is that while the complications are not pathogenically related they tend to occur together more frequently than expected by chance
V: Vertebral Defects (Spina bifida) A: Anal anomaly (usually imperforate) C: Cardiac defect (usually VSD) TE: Tracheo Esophageal fistula or Esophageal atresia R: Radial or Renal dysplasia L: Limb deformities |
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Term
does gastrochisis surgery need an awake intubation |
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Definition
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Term
is gastroschisis or omphaolocele have a larger insensible loss |
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Definition
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Term
Describe signs and symptoms of pyloric stenosis, what labs can you expect |
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Definition
In 3-6 weeks post partum neonate will develop non-bilious projectile vomiting after meals b/c of stenotic pylorus.
Labs 1. hypochloremic AND 2. hypokalemic metaoblic alkalosis 3. dehydration |
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Term
Name three surgical emergencies that need an awake intubation |
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Definition
1. trachea-esophageal fistula 2. pyloric stenosis 3. diaphragmatic hernia |
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Term
what airway / respiratory concerns would you have with a child who has pyloric stenosis. |
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Definition
due to their metabolic alkalosis from constant vomiting and loss of Cl and K ions. The patient may compensate with hypoventilation to increase CO2. So be very careful with pain meds since their autoregulation has changed. |
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Term
congenital diaphragmatic hernia is most common on what side of the body |
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Definition
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Term
the diaphragmatic hernia most commonly enters what area into lung |
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Definition
on left side it enters the foramen of botulek |
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Term
why do we deliver diaphragmatic hernia patients via c-section |
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Definition
b/c we dont want the high pressures exerted on the fetus during passage through the pelvis since this may increase the hernia and bowel cephald. |
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Term
If patient has congenital diaphragmatic hernia what should you consider for their surgircal preop |
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Definition
1. No BAG mask 2. awake intubation 3. no N2O 4. limit PIP to 28cm H20 |
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Term
which surgical emergency in kids may require ECMO |
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Definition
diaphragmatic hernia since associated with lots of other problems. |
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Term
what diagnostic finding would indicate necrotizing enterocolitis |
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Definition
pnumatosis interstinalis on KUB
s a radiological sign which is highly suggestive for necrotizing enterocolitis. Pneumatosis intestinalis refers to gas cysts in the bowel wall.[1] This is in contrast to gas in the intestinal lumen. The air is produced by bacteria in the bowel wall. |
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Term
necrotizing enterocolitis is mostly seen in what age pedi and from what |
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Definition
in preemies 2nd to mucosal ischemic injury from PDA or bacterial etiology
So patent ductus arteriosus results in a right to left shunt and deoxygenated blood entering neonates systemic circulation and causing ischemic injury to the mesenteric system. |
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Term
if surgical ligation is needed to fix a patent ductus arteriosus what two surgical complications are possible with this surgery. |
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Definition
1. left sided recurrent nerve injury #1 risk injury
2. also worry about aortic artery auvlsion |
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Term
whats the difference between the meningeocele and myelomeningeocele |
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Definition
menigeocele contians meninges only while myelomeningeocele contains neural tissue + meninges |
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Term
what are the associated Sx with myelomeningeoceles |
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Definition
1. club foot 2. hydrocephalus ** 3. dislocated hips 4. klippel-Feil syndrome 5. cardiac defects 6. GU defects 7. Latex allergy |
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Term
what allergy is closely associated with myelomeningeocele |
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Definition
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Term
to operate on a pedi patient they should be at least how old after birth |
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Definition
> 46 weeks post CONCEPTUAL AGE |
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Term
what kind of monitoring do pediatric patients need |
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Definition
24 hour post op cardio/pulmonary monitoring needed |
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Term
what does the EXIT procedure stand for? What's it used for |
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Definition
EXIT Ex-Utero I: Intrapartum T: Therapy Used for when we know there is airway compromise pre=op.
So if baby can't breath or management airway and they know this, then they will pop baby's head and neck out of C-section just long enough to create an airway surgically before they baby is fully delviered and the cord clamped. |
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Term
bulging, tense fontanelle indicates |
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Definition
increased ICP from: 1. CNS infections 2. neoplastic disease 3. hydrocephalus |
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Term
an enlarged posterior fontanelle may be present from |
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Definition
congenital hypothyroidism |
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Term
in croup is there a prolong inspiration or expiration |
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Definition
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Term
is croup an upper or lower airway obstruction |
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Definition
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Term
describe some normal benign murmurs in infants/new borns |
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Definition
newborns can have a transient soft, ejection murmur in the left upper sternal border due to a closing ductus. |
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Term
most common benign heart murmur in childhood is |
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Definition
a still murmur. It is muscial and early mid-systolic. |
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Term
When does the nadir of physiological anemia occur and what Hb levels should you expect in:
1. Full-term infants
2. Premature infants |
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Definition
At the nadir of the physiologic anemia in
1. full-term infants, hemoglobin levels may be as low as 9.5 to 10 Gm. per 100 ml. at 6 to 8 weeks of age,
2. premature infants 6 to 7 Gm. per 100 ml. at 3 to 7 weeks of age. |
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Term
Describe:
1. Gestational Age
2. Conceptual Age
3. Corrected Age
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Definition
1. Gestational Age: “Gestational age” (or “menstrual age”) is the time elapsed between the first day of the last normal menstrual period and the day of delivery
2. Conceptual Age: Time of conception (2 weeks after last period) + time since birth.
3. Corrected Age: Corrected age” (or “adjusted age”) is a term most appropriately used to describe children up to 3 years of age who were born preterm Corrected age is calculated by subtracting the number of weeks born before 40 weeks of gestation from the chronological age. Therefore, a 24-month-old, former 28-week gestational age infant has a corrected age of 21 months according to the following equation:
[image] |
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Term
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Definition
Kernicterus: bilirubin-induced brain dysfunction. Bilirubin is a highly neurotoxic substance that may become elevated in the serum, a condition known as hyperbilirubinemia. |
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Term
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Definition
SGA: is small for gestation age. Not all SGA babies are IUGR.
2. IUGR: Intra-uterine growth restrctions. IS at times interchangable with SGA. But this one is pathological with poorer outcomes. |
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Term
Klippel–Feil syndrome is? concerns for anesthesia include? |
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Definition
congenital fusion of any 2 of the 7 cervical vertebra. So limited range of motion in neck. The most common signs of the disorder are a short neck, low hairline at the back of the head, and restricted mobility of the upper spine. This syndrome is associated with numerous other congenital problems. |
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Term
in neonates normal urine specific gravity is |
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Definition
In neonates, normal urine specific gravity is 1.003.. Its low because they have a very difficult time concentrating urine due to immature tulbuar cells |
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Term
List causes of jaundice in kids |
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Definition
1. Increase RBC destruction
2. premature kids (under developed livers)
3. Drugs that compete with unconguated bilirubin for Albumin bidning (lasix, diazepam, sulfonamids) |
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Term
What IV solution can you use for maintenance that closely resembles body fluids |
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Definition
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Term
which GI issue is an emergency and you DO NOT BAG VALVE MASK |
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Definition
Congenital Diaphragmatic Hernia. Awake intubation and Do not pre-bag b/c you do not want to cause gastric distension and further cephald movement of GI into thorax. |
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Term
necrotizing enterocolitis is found in what patient populations |
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Definition
1. preemeis and is a primary disease 2. Children as a result of Mucosal ischemic injury |
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Term
IF necrotizing enterocolitis is a 2nd etiology from ischemia then you know what two things are often culprits and put kids at greater risk |
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Definition
1. PDA 2. Bacterial etiology |
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Term
3x major s/e and concerns for a person with myelomeningeocele |
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Definition
1. risk for large amt of 3rd speacing 2. hypothermia 3. neural tissue damamge |
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