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10 Cards in this Set
- Front
- Back
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The ABC of Paeds |
A = Age. (weight = Age+2 x 4). ETT = Age/4 + 4 uncuffed.
B = breathing. T-piece under 25kg. C = Circulation. fluid bolus 20ml/kg x 2, then blood 10ml/kg. D = Drugs. Sux 2/4mg/kg, atropine 20mcg/kg, adrenaline 0.1ml/kg 1:10,000. Prop 3-5mg/kg. MAC? E = Energy. 4J/kg as a shock. nearest 10J. |
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Paed Common Issues
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Age related issues
Parents on induction Premed Emergence delerium Preop Ax of - heart murmur, URTI |
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Preop Assessment of a Heart Murmur
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Hx
- ex-prem? Syndrome? - Hx of Ix/consultation when younger - Feeding, development, FTT - ability to keep up - recurrent chest infections - cyanotic spells, syncope, squatting - Family Hx (HOCM) Ex - Pulses (coarctation) - other peripheral signs (ascites, oedema, hepatomegaly, LVF, SATS) - Murmur *timing (diastolic, pansystolic, late systolic all BAD), quality (loud, harsh vs soft/musical) *position changes (ie, venous hum disappears on lying flat) Ix - ECG RVH = tall R wave in V1 (>2.5 big squares), upright t wave LVH = tall r wave in V5/6 (>8 squares), TWI inferolaterally "strain" - Echo Murmurs in < 1yo should be evaluated before elective surgery. Feel free to discuss with Cardiology!! |
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Preop Ax of the Kid with an URTI
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Criteria for cancellation
- Age < 1 - Unwell looking, malaise - Febrile - LRTI signs - Purulent nasal discharge - Parents concerned - major surgery? - comorbidities particularly Respiratory Hx/Ex - recent onset (might be more than a cold, ie, measles) - still playing, running around? - off food? - nasal discharge, wheeze, moist cough, fever - recurrent URTI's - parental smoking, parental concern May need to postpone for 2/52. Otherwise just Mx respiratory Cx. Patient - comorbidities, prematurity, age - parental smoking Anaesthetic - ETT>LMA>FM - Desflurane > Sevo > Propofol - experience Surgical - ENT - Major Could use bronchodilators preop (controversial) Lignocaine pre-instrumentation (controversial) Extubate Deep Prepare for laryngospasm - CPAP/100% O2, Propofol, Sux, Help if desaturates. |
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How to anaesthetise a child
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My plan is to perform an IV induction.
I would pre-med the child with.... (EMLA, paracetamol, midazolam 0.5mg/kg) I would prepare the induction room with (assistant, drugs including atropine/sux, ETT of size...., monitoring). I would have the parent in the room on induction, with a nurse to specifically care for them and take them out. I would give propofol....mg/kg I would perform a gas induction, with sevo in 100% O2, and flavoured mask. When depth of anaesthesia is adequate (eyes midline, RR regular), I would place...ETT/LMA. |
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Management of Laryngospasm
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- 100% O2, identify and remove offending stimulus if present
- monitoring attached - CPAP with FM, laryngospasm notch, jaw thrust (any parent in room should LEAVE) - Call for help if desaturation - If no IV access - IM Sux/atropine, then ETT. Ask assistant to gain IV access, or do after ETT. |
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Issues with..... Scoliosis
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- Cause
Idiopathic (70%), trauma, malignancy, neuromuscular, infectious. watch out for DMD, CP. - Complications Depends on severity. Surgery if >40-50% Cobb angle, Restrictive lung disease if > 60% (may have pulmonary hypertension). If > 100% Cobb angle, of VC < 50%, then at risk of periop resp cx. Need RFT's, TTE. - Other preop considerations Anaemia, G/H. Intraop - long surgery. May need prone (posterior), or lung isolation (anterior). PAC, temp, monitoring - blood loss, blood conservation - Spinal cord monitoring (SSEP's, MEP's - anaesthetic technique important). Postop - Blood loss (1/3 postop) - analgesia - HDU? Even ventilation if bad resp fn preop. |
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Issues with.... Pyloric Stenosis....
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Usually term baby presenting around 6-8 weeks old.
Projectile, non-bilious vomiting, and hungry. Dehydrated, metabolic alkalosis. Acid-base / electrolyte disturbance - Hypochloremic, hypokalemic, metabolic alkalosis - alkaline, then paradoxical acid urine (due to need to try and conserve Na - causes loss of K and H+, also electroneutrality and conservation of Cl) Preop - medical not surgical emergency - requires resuscitation, and normalisation of acid-base disturbance prior to surgery *accept Na > 135, Cl > 105, HCO3 < 26, K > 3.5, lactate normal, urinary Cl > 20. * Should be volume resuscitated, including replacement of NG losses (often at higher maintenance rates such as 6-8ml/kg/hr with KCL) Intraop - prepare OT - warm - sizing of tubes - suction of stomach, and RSI - usually just need paracetamol/LA (open) - opioids may increase risk of postop apnoea Postop - paracetamol - apnoea monitoring |
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Apnoea Monitoring
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An Apnoea is defined as > 15 secs, or with associated bradycardia or desaturation (HR<100-110, sats < 94%).
Monitoring should continue for 24 hrs, or until 12 hrs after the last apnoea. Line of sight nursing should be done. |
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Issues with.... Down's Syndrome
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Down's Syndrome is a chromosomal abnormality (Trisomy 21), resulting in many potential abnormalities of relevance to anaesthesia.
A - potential airway issues. Atlanto-axial instability, macroglossia, micrognathia, subglottic stenosis (small tube). B - OSA. Hypotonia, and resp Cx. recurrent chest infections. C - up to 50% have CHD (most common ASVSD). possible PHT. bradycardia from sevo. D - developmental delay. early onset dementia. epilepsy. E - Hypothyroidism F - sensitivity to volatiles, atropine G - GORD. GI atresia. H - polycythemia, increased risk haem malignancy I - infection J - AAS (10-20%) |
