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194 Cards in this Set
- Front
- Back
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what is prematurity
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infants weighing < 2500 gms at birth
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what is a preterm infant
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infants born before 37 completed weeks of gestation
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what is term infant
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infants born after 37 and before 42 completed weeks of gestation
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what is post term infant
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infants born after 42 wks completed of gestation
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What to know about exotoxins released by Clostridium tetani
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Blocks the release of inhibitory neurotransmitter glycine from Renshaw cells in the spinal cord. Causes "lockjaw"
Mnemonic - Blocking Renshaw will give you Lock Jaw |
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what is very low birth weight (VLBW)
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< 1500 gms
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what is extremely low birth weight
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< 1000 gms
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what is a micropremie
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< 750 gms
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at what age in infant development lack surfactant
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less than 24 wks
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what are the methods for measuring gestational age
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*measuring crown to rump length of the fetus
*calculating mothers LMP *dubotwitz scoring system |
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what is the most accurate method for measuring gestational age
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measuring crown to rump length of fetus
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what is an inaccurate method for measuring gestational age
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calculating the mothers LMP
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what is the dubowitz scoring system
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it uses neurological and external physical criteria
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what is small for gestational age (SGA)
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wt below 10th percentile at gestational age
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what is appropriate for gestational age (AGA)
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wt within normal (10-90th) percentile
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what is large for gestational age (LGA)
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wt above 90th percentile at gestational age
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what does large for gestational age result from
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organomegally and increase in deposition of subcutaneous fat secondary to increase in fetal insulin
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what are the complications that can occur with AGA
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*resp distress syndrome
*hypoglycemia *hypocalcemia *hypomagnesemia *hyperbilirubinemia |
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what are the complications that can occur with LGA
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*birth trauma
*hyperbilurubinemia *hypoglycemia |
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what trimester is the most important phase in development
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first
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during what trimester does rapid growth and functional development of the organs occur
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second
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during what trimester does fetal growth and things such as wt gain, subcutaneous tissue and development of muscle mass occur
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THIRD
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in the FIRST trimester the heart is found where
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vertically in pharyngeal region and later migrates to the thorax
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at what week do the heart tubes connect with the arterial and venous systems
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3rd week
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when in development do lung buds appear as diverticulum in embryonic foregut
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26 days
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when do segmental bronchi appear
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day 52
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when is the diaphram complete
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day 52
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lung development occurs how
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in 3 stages
*glandular stage *canalicular stage *terminal saccules/aveolar stage |
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when does the glandular stage occur
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7-16 wks
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when does the canalicular stage occur
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16-24 wks
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when does the terminal saccules/alevolar stage occur
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24 wk to term
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what is the glandular stage
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intersegmental airways with associated vessels
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what is the canlicular stage
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*growth liquid fill airways
*viable gas exchanging surface devlops *production of surfactant |
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what is the terminal saccules/alveolar stage
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formation of alveolar ducts and saccules
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bronchial tree and terminal bronnchial form when
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by 16th week of gestation
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when do alveoli develop
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mainly after birth and increase in number and size until chest cavity stops growing
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pulmonary arteries/veins develop when
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accompany the pattern of the bronchial tree at 16th week of gestation
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when does the surface of the lungs develop gas exchanging ability
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24 wks gestation
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when does surfactant production in type II pneumocytes occur
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24 wks gestation
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when does surfactant increase in amniotic fluid
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24 wks gestation
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surfactant increases in amniotic fluid provides a clinical indicator of what
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lung maturity
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incidence of resp distress syndrome declines greatly after when
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24 wks gestation
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the CV system is predominantly under PS or sympathetic control in utero
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PS
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the CV system is under PS or sympathetic control after birth
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sympathetic
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what is the mean HR for newborn-24 hrs
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120
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what is the mean HR for 24 hrs to 1 mo old
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160
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what is the mean HR for 1 mo to adolescence
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gradual decrease from 160 to 75
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the newborn myocardium is immature and this results in what
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decreased stroke volume
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in the newborn cardiac output is dependent on what
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HR
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atropine does what to newborn HR
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increases it
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epi does what to newborn HR
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increases contractibility and HR
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calcium chloride does what to newborn HR
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increases contractibility
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what is the mean systemic BP for a newborn to 12 hrs
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65
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what is the mean systemic BP for a newborn 12 hrs -4 days
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75
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what is the mean systemic BP for a newborn 4 days to 6 wks
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95
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what amt of neonates void within 24 hrs after birth
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>90%
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what amt normal neonates void within 48 hrs after birth
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100%
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GFR at birth is what
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15-30% normal adult fxn
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what is GFR 5-10 days after birth
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50% normal adult fxn
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what is GFR 1 yr after birth
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100 adult fxn
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tubular fxn develops rapidly after when
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34 wks gestation
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ability to concentrate and dilute urine occurs when
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2-3 yrs
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hepatic fxn is mature or immature at birth
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IMMATURE
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do newborns have the ability to metabolize proteins and drugs
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NO
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in the first 4 hours neonates lose what amt of blood and plasma volume
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25%
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what is significant regarding vit K factors and neonates
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factors II, VII, IX and X are only 20-60% of adult values
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what type of Hgb is predominant in the newborn
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fetal Hgb
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what is significant about fetal hgb
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it has a higher affinity for o2 than adult hgb
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fetal hgb allows what for neonates regarding PaO2
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allows fetuses to exist in a relatively low PaO2 environment
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head circumference reflects what
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growth of brain and intracranial volume
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large head circumference indicates what
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hydrocephalus
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small head circumference indicates what
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abnormal brain growth (craniosynotosis)
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at 9 months the head circumference is what of adult size
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50%
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at 1 yr the head circumference will grow how much
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up to 10 cm
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at 2 yrs the head circumference will grow how much
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another 2.5 cm
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at 2 yrs the head is what amt of adult size
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75%
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which fontanelle closes sooner
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posterior
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which fontanelle can be used to assess hydration status
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anterior
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a bulging fontanelle can indicate what
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*increased ICP
*hydocephalus *infection *hemorrhage *increased PaCo2 |
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when does the ant fontanelle close
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9 to 18 mo
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when does the posterior fontenelle close
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4 mo
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the first tooth erupts when
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6 mo
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all deciduous teeth are complete when
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28 mo
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permanent teeth appear at what age with shedding of deciduous teeth
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6 yrs
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look for loose teeth at what age range
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5 - 10 y/o
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what is the major goal of the pre-op visit
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relieve stress and anxiety
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herbal remedies should be d/c'd how long before sx
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2 wks
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chinese herbal remedies are twice as likely to cause what
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*hypokalemia
*impaired hemostasis |
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what herbal remedies increase the risk of bleeding
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*garlic
*ginseng *ginkgo biloba |
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what herbal remedy most commonly interacts with anesthetics and drug metabolism
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st. johns wort
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what herbal remedy is a potent inducer of CYP450 and p-glycoprotein
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st. johns wort
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what s/e does st. johns wort have
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can cause CV instability, coagulation disturbances, prolonged anesthesia and immumosuppression
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with sz disorders what anesthesia related medications may need to be avoided
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*ketamine
*enflurane |
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how long prior to sx can a child have clear liquids
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2 hrs
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how long prior to sx can a child have breast milk
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4 hrs
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how long prior to sx can a child have infant formula
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6 hrs
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how long prior to sx can a child have solids
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8 hrs
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what age range is rectal pre-op usually used for
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1-4
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what is the rectal dose for tylenol pre-op
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30 mg/kg
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what is the rectal dose for thiopental pre-op
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30 mg/kg
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what is the rectal dose for brevital (Methohexital) pre-op
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30 mg/kg
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what is the age range for intranasal pre-op meds
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1-4
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what is the usual medication for intranasal pre-op
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combo
fentanyl (2 mcg/kg) versed (0.2 mg/kg) lidocaine (0.2 cc) |
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what is the drawback to intranasal pre-op sedation
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it burns from the benzyl alcohol in the versed
(lidocaine is used to help this) |
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what is the age range for the oral medication pre-op
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4-12
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what is the dosage for oral versed for pre-op sedation
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0.5 mg/kg
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what are the disadvantages of oral versed for pre-op sedation
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*N/V
*unappealing taste |
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what is the age range for IV pre-op sedation
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> 13 y/o
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what is the IV dosage for versed pre-op sedation
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0.05-1 mg/kg
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what is the dose for chloral hydrate
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50-100 mg/kg
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when should chloral hydrate be given before the procedure
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1.5 to 2 hrs
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what type of derivative is ketamine
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phencyclidine
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what are the routes that ketamine can be given
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*IV
*IM *PO *intranasal *rectal |
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what are the disadvantages to ketamine
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*increased oral secretions
*nystagmus *post-op N/V *hallucinations/delirium/nightmares |
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what is the IM dose for ketamine
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2 mg/kg
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how much versed should be given with the IM dose of ketamine
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0.1 to 0.2 mg/kg
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what is the oral dose of ketamine
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5-6 mg/kg
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what is the nasal dose of ketamine
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6 mg/kg
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what is the rectal dose of ketamine
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5 mg/kg
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information travels how to regulate body temp
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from the spinothalamus to the hypothalamus
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cutaneous blood vessels regulate heat loss how
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*conduction
*convection *radiation |
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sweat glands regulate heat loss how
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evaporation
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what is the best way to keep the pt warm
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warm the room
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how do premature kids have increased heat loss and what kind
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by having a thin keratin layer it increases evaporative heat loss
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an uncovered head equals how much heat loss
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60%
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what are the 4 methods of heat loss in the OR
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*radiation
*evaporation *convection *conduction |
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conduction is heat loss how
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to the environment
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convection is heat loss how
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moving air current
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evaporation is heat loss how
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open body cavity (skin and lungs)
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radiation is heat loss how
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one object to another
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a size 1 LMA is for what size pt
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neonate and infant < 5 kg
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a size 1.5 LMA is for what size pt
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infant 5-10 kg
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a size 2 LMA is for what size pt
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infants and children 10-20 kg
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a size 2.5 LMA is for what size pt
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children 20-30 kg
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a size 3 LMA is for what size pt
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> 30 kg
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a size 4 LMA is for what size pt
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normal adults 50-79 kg
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a size 5 LMA is for what size pt
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> 70 kg
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where is the fresh gas inlet on a mapelson A (magill circuit)
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near reservior bag
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where is the expiratory valve on a mapelson A (magill circuit)
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near mask
(seperated from bag by corrugated tubing) |
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with a mapelson A (Magill circuit) the volume of breathing tube should be as great as what
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tidal volume
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which is the most efficient of mapelson circuits
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mapelson A (magill circuit)
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what is a mapelson A "lack" modification
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*has added coaxial expiratory limb
*expiratory valve moved near reservoir bag |
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with the mapelson B FGF is where
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near the expiratory valve
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which mapelson circuit is INefficient during spontaneous and controlled ventilation
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mapelson B & C
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which mapelson circuit has inefficiency in terms of carbon dioxide elimination and FGF utilization
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mapelson B
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what kind of breathing tubing does the mapelson B have
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corrugated
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with the mapelson C where is the FGF
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near the expiratory valve
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what mapelson has shorter non-corrugated breathing tubing therefore less dead space
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mapelson C
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which mapelson has LONG corrugated breathing tubing
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mapelson D
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with the mapelson D where is the FGF
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near mask
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with the mapelson D where is the exhalation valve
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at distal end of tubing
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which mapelson is the most efficient during controlled ventilation
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mapelson D
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what is the mapelson D "bains" circuit
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modification of the mapelson D
*fresh gas supply tube placed coaxilly |
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which mapelson has warming of inspired gases
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mapelson D "bains" circuit
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which mapelson is used extensively in peds anesthesia
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mapelson D "bains" circuit
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which mapelson is valveless
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bains circuit
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with the mapelson E where is the FGF
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close to the mask
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with the mapelson E what acts as the reservior
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the corrugated tube
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which mapelson is a modification of Ayers T-piece
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mapelson E
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with the mapelson F where is the FGF
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close to mask
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what kind of breathing tube does the mapelson F have
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corrugated
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which mapelson has a reservior bag with expiratory port but no expiratory valve
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mapelson F
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with an ASA class I what is the mortality rate
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0.08%
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with an ASA class 2 what is the mortality rate
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0.27%
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with an ASA class 3 what is the mortality rate
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1.82%
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with an ASA class 4 what is the mortality rate
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7.76%
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with an ASA class 5 what is the mortality rate
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9.38%
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what lab test should be performed pre-op for men under 40
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none
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what lab tests should be perfomed for women under 40
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HCG
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what lab tests should be performed for men 40-50
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ECG
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what lab tests should be performed pre-op for women 40-50
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Hct, HCG
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what lab tests should be perfomed pre-op for men 50-65
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ECG
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what lab test should be performed pre-op for women 50-65
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ECG, Hct
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what lab tests should be performed pre-op for men and women 65-75
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*Hct
*ECG *BUN |
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what lab tests should be preformed pre-op for women and men > 75
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*hct
*ECG *glucose *BUN *CXR |
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with adults clear liquids can be given how long prior to sx
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2 hrs
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with adults solid foods can be given how long before sx
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6 hrs
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breast milk can be given how long before sx
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4 hrs
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infant formula/non-human milk can be given how long before sx
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6 hrs
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prescribed medication can be given with a sip of water how long before sx
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1 hr
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class 1 ASA
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normal healthy pt
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class 2 ASA
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mild system disease with no functional limitations
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class 3 ASA
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moderate to severe system disesase with some functional limitation
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class 4 ASA
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severe system disease presenting a constant threat to life with functional incapacitation
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class 5 ASA
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moribund patient who is not expected to survive with or without surgery
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class 6 ASA
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brain-dead patient for organ harvest
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grade 1 laryngoscopic grading
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visualization of the complete laryngeal opening
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grade 2 laryngoscopic grading
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visualization of just posterior area
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grade 3 laryngoscopic grading
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visualization of just eppiglottis
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grade 4 laryngoscopic grading
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visualization of just soft palate
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tonsilar size +1 is what percent
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25%
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tonsilar size +2 is what percent
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<50 > 25
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tonsilar size +3 is what percent
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>50 <75
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tonsilar size +4 is what percent
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>75
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