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63 Cards in this Set

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FRC/TLC in peds vs adults?
Same
Which lung parameters are changed in peds pts?
FRC, VC, PaO2 are decreased
MV, RR, MV/FRC increased
At what level is the glottis in infants vs adults?
C3-4 vs C5-6 in adults
Why do peds pt desaturate faster than adults?
Primary reason is higher metabolism and secondariy higher MV/FRC
Narrowest part of pediatric airway compare to adults?
Cricoid cartilage vs glottic opening in adults.
Infants total body water %age when compared to adults?

Extracellular fluids?
80% vs 60% for adults.


40% vs 20% for adults
Why is induction of VA faster in infants?
higher MV/FRC ratio
What is the sensitivity of infants to sux?
Less sensitive
Hypoglycemia in infants of < 4.5 meq/l can present as?
seizures, tetany, laryngospasm, hypotension.
What is the dose of Sux (IV vs IM) in children?
2mg/kg IV
4mg/kg IM
MAC:
infants vs adults
Neonates vs adults
infants vs adults > 40%
Neonates vs adults > 15%
Complications of Bicarb administration in children?
cerebrel edema
hemorrhage
hypernatremia
hypercarbia
Most common type of tracheoesophageal fistula?
Upper esophagus ends in blind pouch.
Lower esophagus attach to the back of the lower trachea.
What is the preferred method of intubation for tracheoesophageal fistula?
1) Awake intubation if possible. 2) Inhalation induction with SV, ETT advance until R main stem, tube pulled back until BS are heard in stomach, then advance until, BBS.
What procedure is critical for preventing gastric distension and aspiration in TEF?
Gastrostomy
When should paralysis begun in TEF?
once chest is opened and fistula is ligated
When should one defibrillate in peds?

What is the energy in joules?
Vfib or SVT

2 joules/kg
Mechanism of hypoglycemia in neonates?
Occurs in infants of diabetic mothers because during pregnancy glucose crosses the placenta but insulin does not. After birth glucose does not cross but neonatal pancreas insulin is acitve.
Defined neonatal hypoglycemia?

How do you treat it?
blood sugar < 20-30mg/dl

give 20% glucose (1-3cc/kg) over 5min
What is hypocalcemia in neonates?

Sx's?
< 4.5meq/l

seizures, tetany, laryngospasm, hypotension
What is the diagnosis if unable to insert suction catheter through each nares?
Choanal atresia
How do you initially manage pt with choanal atreasia?
oral airway
What medication closes PDA?
indomethacin
What is a complication of PDA repair?

How does it present?
Recurrent laryngeal nerve damage

Hoarseness
Name some R --> L shunts?
TOF
Transpostion of great vessels
Pulm stenosis with ASD
Eiesenmenger's syndrome
What kind of shunt not improve by increasing FiO2?
R to L shunt
How does R --> L shunt affects:

IV induction?

VA induction?
IV induction = speeds induction

VA induction = slows induction
How does L --> R shunt affects:

IV induction?

VA induction?
IV induction = slows induction

VA induction = if normal CO no effect, if low CO then speeds
Vomiting in neonates with bile present, where is the obstruction?
below the ampulla of vater
Pyloric stenosis chem and ph derangements?
hypochloremic, hypokalemic, Hypdontremic, metabolic alkalosis.

If severe dehydration can have metabolic acidosis.
If a child weighed 4kg 2 days ago and now is 3kg, how many cc of water is lost?
1000cc/kg
Induction for pyloric stenosis?
RSI
Under what post conceptual age must a pt be held overnight after surgery.
<60 wks

2/2 to risk of apnea
Herniation of abd viscera into base of umbilical cord with a covering sac?
Omphalocele
abd wall eviscerates thru lateral defect with no membrane covering sac?
Gastrochisis
After repair of omphalocele/gastrochisis the pt vitals signs are unstable and compromised, what is the next step.
open the abdomen.
Scaphoid abdomen and bowel sounds heard in the chest.
congential diaphragmatic herniation
Where is the defect that most often occur in CDH?
Left posterior foramen of Bochdalek
Most common complicaton of CDH?
contralateral PTX usually caused by barotrauma.
Anesthesia for CDH
VA, fentanyl, muscle relaxant, no no no N2O.
Thumb print sign on lateral neck x-ray, usually bacterial, sore throat, fever, pt sitting up and leaning forward, drolling.
Acute epiglottitis
Tx for acute epiglotitiis
intubation and abx (ampicillin)
Neck x-ray shows steeple signs, stridor, inspiratory cough.
Croup
tx for Croup
O2, cool mist, racemic epi, dexamethasone
Which (acute epiglottitis or croup) is supraglottic and which in subglottic?
Acute epiglottitis is supraglottic

Croup is subglottic
Largest component of heat loss in children?
Radiation
Micrognathia, congenital heart dsz, cleft palate, glossoptosis.
Pierre Robin Syndrome
Tongue differences between Pierre Robin vs Treacher Collins?
PR = floppy tongue that falls back causing asphyxiation

TC = small tongue
Management of Pierre Robin and Treacher Collins syndrome
Inhalational induction, SV with FOBI, ENT standby for surgical airway.
Signs and symptoms of hypoglcemia in neonates?
Irritabiliy, seizures, apnea, and bradycardia
Caudal dose
0.25% bupi with epi
1cc/kg
First signs of high spinal in peds.
respiratory depression and hypoxia
For retinopathy of prematurity:
What should the Sat/PaO2 be?
Until what weeks Post-con age?
Sat 93-95%
PaO2 <80
Until 44 wks PC age
Neonate--infant--5yo--adult
Sys BP
HR
Hgb
blood vol
Sys BP: 65--90--95--120
HR: 130--120--90--80
Hgb: 17--11--13--14
BV (cc/kg): 85--80--75--65
Which neonatal condition is associate with increase incident of congenital heart dsz?
omphalocele
In neonates spinal cord ends at?
L3
Most common initial sx of esophageal atresia and tracheoesophageal fistula?
regurgitation during feeding
Omphalocele with macrosomia, macroglossia, hypoglycemia
Beckwith-Wiedeman Syndrome
age of infants?
3-12mos
PVR in infants is elevated but approaches that of adults by?
1yr of life
What is the fluid replacement in 1st 24hr if 40kg child with 50% burn.
4x40x50% = 8.0L
Preterm infant displays irritability, seizure, hypotension?
give calcium

hypoglycemia would sometimes have apnea and brady cardia.
EMLA cream consists of?
Lidocaine and prilocaine