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Principles Anesthesia Exam II
Exam II principles
193
Nursing
Graduate
07/10/2009

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Term

Calculation of Total Blood Volume:

1) Premature neonate

2) Infant

3) Child

4) Adult male

5) Adult female

6) Obese adults

Definition

1) 90 ml/kg

2) 85 ml/kg

3) 80 ml/kg

4) 75 ml/kg

5) 65 ml/kg

6) 55 ml/kg

Term
How do you calculate allowable blood loss without a hct/hgb?
Definition

Estimated Blood loss x 20%

Can be used to ballpark allowable blood loss in healthy pts.

Term
Calculate transfusion trigger:
Definition

1) Determine pt's blood volume

2) Determine Healthy HCT

3) Determine Trigger HCT

4) Multiply each above by blood volume

5) subtract healthy HCT volume from Trigger HCT

6) Multiply this number x 2 to get transfustion trigger point.

Term
How do you determine transfusion trigger?
Definition

For most healthy adults Hgb of 7-8 g/dl or HCT of 21-24%

For elderly the target is set at: 10 g/dl hgb (remember hgb to hct is 1:3 approx)

Term
What are the guidlines for pediatric Hct's and acceptable Hct's?
Definition

             Normal     (x)       Acceptable

Premature:   40-45      45          35

Newborn:     45-65      54          30-35

3 months:    30-42      36           25

1 year:         34-42      38         20-25

6 years:        35-43      38         20-25

Term
What does CPDA Stand for?
Definition
Citrate, phosphate, dextrose, adenosine
Term
in PRBC's Platelets lose function how quickly?
Definition
1-2 days
Term
Stored RBCs are stored at what temp?
Shelf life of?
HCT of?
Definition
1-4 degrees, 42 days, 70%
Term
1 Unit of PRBCs will raise the adult Hgb/ Hct by how much?
Definition
1 gm/dl Hgb, and 3% HCT in 70 kg adult
Term
In a child 10ml/kg of PRBCs will raise the hgb/ hct by how much?
Definition
Hgb 3 gm/dl, HCT 10%
Term
In a child 3 ml/kg of PRBCs will raise the Hgb/ hct by how much?
Definition
Hgb 1 gm/dl, HCT by 3%
Term
Which plasma proteins and clotting factors does FFP contain?
Definition
All of them, but factors 5 and VIII are very labile.
Term
What is FFP used for?
Definition
correction of coagulopathy,
(ie:Liver disease,Coumadin reversal, massive blood transfusions,antithrombin III deficiency)
Term
What dose of FFP do you give to increase clotting factors? What dose do you give to reverse coumadin?
Definition
Clotting factors: 10-15 ml/kg,

Coumadin reversal: 5-8 ml/kg
Term
A dose of 10-15 mg/kg of FFP will increase clotting factors by?
Definition
30%
Term
Platelet counts less than what are assoc. with inc. blood loss during surgery?

Plt. counts less than what are assoc. with spont. bleeding?
Definition
<50,000, and <20,000
Term
How long to transfused plts survive?
Definition
1-7 days
Term
How much plasma is in a unit of platelets?
Definition
approx 70ml/ unit
Term
1 unit of plts will increase the plt. count of an adult by how much?
Definition
5,000-10,000/mm3 in adult.
Term
What is the dose for plts in infants and children?
Definition
10 ml/kg up to 30 kg.
Term
How do you raise the plt count by 50,000 mm3 in older children?
Definition
Give 1 unit/ 10 kg.
Term
What size filter for plts?
Definition
170 micron filter but no smaller
Term
What can happen to plts d/t multiple blood transfusions?
Definition
Lead to antibody formation that destroys plts.
Term
How long are plts good for in storage?
Definition
up to 5 days with continuous agitation stored at room temp
Term
What does cryoprecipitate contain?
Definition
Factors I, VIII, XIII, Fibrinogen and von Willebrands factor.
Term
When is cryoprecipitate used?
Definition
When fibrinogen levels are low, factor VIII deficiency(hemophilia A) and von Willebrands disease.
Term
What is the normal fibrinogen level?
Definition
200-400 mg/dl
Term
When do you transfuse cryo?
Definition
fibrinogen levels less than 100mg/dl
Term
How do you dose cryo? How will the fibrinogen levels be affected?
Definition
1 unit/10 kg in adults and children. This will increase fibrinogen levels 50-60 mg/dl
Term
What are the symptoms of acute hemolytic reaction under anesthesia?
Definition
Rise in temp, unexplained tachycardia, hypotension, hemoglobinuria, oozing.

DIC, shock, and renal failure can occur quickly
Term
What is the most common rxn to infused blood products? What should you do with a pt w/ a hx of this rxn?
Definition
Febrile rxns.(3-5% incidence) Increase in temp of > 1 degree C. Pts with this hx should be given leukocyte-poor transfusions.
Term
This is due to IgA antibodies. You see this rxn almost immediately. Under anesthisia you may see: hives, elevation in airway pressures, wheezing, tachycardia, decreased pulse ox.
Definition
Anaphylactic Rxns.
Term
Pt's white cells aggregate in the pulmonary circulation causing alveolar capillary damage. How quickly does this resolve?
Definition
TRALI (transfusion related acute lung injury) usually resolves in 12-48 hours.
Term
Fatal Neurodegenerative disease from eating contaminated (prion infected) meat.
Definition
Creutzfeldt-jakob disease
Term
What changes do you see in stored blood?
Definition
Inc. plasma K+, Inc. plasma ammonia, inc. red cell lysis, inc. lactate levels, decreased: pH, 2,3 dpg, RBC ATP levels.
Term
What are the s/s of citrate intoxication?
Definition
hypotension, narrow pulse pressure, prolonged Q-T interval, wide QRS complex, coagulopathy (Ca++ is factor IV)
Term
What is the treatment for Citrate Intoxication?
Definition
.2-.25 ml/kg of calcium chloride 10% over 10 minutes. Then recheck ionized Ca++
Term
Why not give LR with Blood products?
Definition
Because LR contains Calcium and calcium will bind with Citrate in blood products. Also LR has lower osmolarity compared to .9 NS. Therefore .9NS is the first choice everytime.
Term
Why do you see Metabolic alkalosis several days after large transfusions?
Definition
Because the liver metabolizes citrate into bicarbonate.
Term
What is the Hct of Cell Saver Blood? How much can we raise the Hgb if we give a unit of cell saver?
Definition
Hct of cell saver: 45-50%

Can raise Hgb approx 1/2 gram
Term
Contraindications to using cell saver?
Definition
Malignancy and Contamination
Term
What is the ideal scenario for Acute Normovolemic Hemodilution?
Definition
Adequate preop Hct, and expected to lose greater than 2 units of blood.
Term
2 major complications of Acute Normovolemic Hemodilution?
Definition
Myocardial ishcemia, and cerebral hypoxia
Term
On average Succinylcholine will raise the serum K+ by how much?
Definition
0.5 meq/ L
Term
How do you emergently treat hyperkalemia?
Definition
1) IF ARRHYTHMIAS PRESENT: Ca. gluconate 10% 5-10 ml IV or Ca. Chloride 3-5 ml IV, 2) Sodium Bicarb .5-1.0 meq/kg (fastest tx. 5-15 minutes) 3) Insulin 10 units with chaser of 30-50 g dextrose 4) Hyperventilation (for every 10 mmHg decrease in PaCO2, serum K+ decreases by .5 meq), 5) Beta 2 agonists, 6) Diuretics, 6) K+ exchange resins (kayexelate)
Term
How do you treat hypokalemia?
Definition
10-20 meq per hour, preferably through central line.
Term
Calcium levels are controlled by the?
Definition
parathyroid hormone, calcitonin, and vitamin D
Term
What is the normal ionized Calcium level?
Definition
1.15 to 1.30 mmol/L
Term
Causes of hypocalcemia:
Definition
hypoparathyroid, vit. D deficiency or malabsorption (ie: anti-seizure drugs), low magnesium, high phosphate, radiation therapy, chemo therapy, large blood transfusions, burns, pancreatitis, resp and met. alkalosis
Term
What does alkalosis and acidosis do to Ca++ levels? Why
Definition
Ca++ inc. with acidosis, decreases with alkalosis. Proteins carry a neg. charge. w/ hyperventilation decrease H+ concentration allowing more Ca++ to bind w/ negative proteins. Opposite occurs w/ acidosis.
Term
What are the hallmark signs of hypocalcemia?
Definition
Membrane irritability and tetany
- tingling and numbness in circumoral region, fingers and toes, tetany may include carpal spasm (trousseaus sign), facial nerve irritability (chvosteks sign), laryngospasm, bronchospasm, resp. arrest.
Term
Causes of hypercalemia?
Definition
Hyperparathyroid, malignancy, Granulomatous diseases (sarcoidosis, tuberculosis), vitamin D intoxication, Immobilization, hypophosphatemia
Term
Symptoms of hypercalcemia?
Definition
Anorexia, nausea, vomiting, dehydration, constipation, somnolence, depression, kidney stones, polyuria, htn, prolonged p-r interval, Shortened Q-T interval
Term
What calcium level is considered a medical emergency?
Definition
Greater than 15 mg/ dl and may require dialysis, phosphate, diuresis with lasix, and calcium binding drugs.
Term
What are the anesthetic considerations for hypercalcemia?
Definition
Hydration, check for other electrolyte imbalances, unpredictable effect on NDMRs, careful positioning (d/t possible osteoporosis) Digoxin toxicity
Term
Total body sodium is regulated by what?
Definition
Aldosterone
Term
Sodium concentration is affected by what?
What regulates this?
Definition
body water, which is regulated by ADH
Term
What causes hyponatremia?
Definition
Most frequently assoc. with inc. in total body water or reduction in sodium secretion. Frequently assoc. w/ defect in urinary diluting.
-diuretics(thiazides),Aldosterone deficiency, Renal failure, liver failure, CHF, Excessive free water, SIADH, TURP procedures, Vomiting and diarrhea, excessive sweating.
Term
Symptoms of hyponatremia
Definition
most assoc. with increased intracellular water.
confusion, lethargy, seizures, coma, death, arrhythmias, muscle cramps, nausea, vomiting.
Term
Treatment of hyponatremia
Definition
-treat cause, infusion of hypertonic sodium chloride, diuresis, water restriction
Term
Anesthetic considerations for hyponatremia
Definition
Okay to give general anesthetics if >130, Reduction in MAC
Term
What causes hypernatremia?
Definition
Most commonly associated with large free water loss or excessive sodium retention.

causes: pt. who don't drink, diabetes insipidus, diarrhea, sweat, Admin of hypertonic solutions, hyperaldosteronism
Term
Symptoms of hypernatremia
Definition
Restlessness, lethargy, hyperreflexia, seizures, coma, death
Term
Treatment for hypernatremia
Definition
rehydration w/ hypotonic and isotonic solution, Vasopressin (for D.I.)
Term
Anesthetic considerations for hypernatremia
Definition
increased MAC, elective surgery cancelled if level > 150 meq/L, profound hypotension with induction drugs.
Term
Primary intracellular electrolyte,
Plays a key role in phopholipid membranes and ATP production.
Definition
Phosphorus
Term
What is the normal phosphorus level?
Definition
2.5- 4.5 mg/dl
Term
What is phosphorus absorption dependent on?
Definition
Vitamin D., also parathyroid hormone inhibits phosphorus reabsorption.
Term
Renal loss, vitamin D deficiency, and alkalosis cause this.
Definition
hypophosphatemia
Term
Symptoms of hypophosphatemia
Definition
Wide spread organ dysfunction, encephalopathy, seizures, coma, death, coagulopathy, plt dysfunction, RBC hemolysis, reduced 2,3 dpg production, cardiomyopathy, resp. failure, liver failure.
Term
Anesthetic implications of hypophosphatemia:
Definition
post op ventilatory support may be necessary, IV replacement may cause hypocalcemia
Term
Symptoms of this are same/similar to hypocalcemia as well as anesthetic considerations. Treatment is phosphate binding antacids. Causes can be: increased intake, decreased excretion or increase in bone release
Definition
hyperphosphatemia
Term
Co-factor in enzyme pathways, antagonizes calcium, regulates release of acetylcholine from nerve terminals absorbed via bowel, excreted via urine, predominantly intracellular component
Definition
Magnesium
Term
What is the normal magnesium level?
Definition
1.5-2.1 meq/L or 1.7-2.4 mg/dl
Term
Causes of Hypomagnesium?
Definition
often assoc. with hypokalemia or hypocalcemia
Term
Symptoms and treatment of hypomagnesium
Definition
symptoms: Electrical irritability, prolonged P-R interval, prolonged Q-T interval, increased Digoxin toxicity, anorexia, weakness, fasciculation, parasthesia, seizures********************************
Treatment: 0.4 mmol/kg of 10% solution
Term
Anesthesia considerations for hypomagnesium
Definition
Correct this and other electrolyte abnormalities, watch for arrhythmias, correct prior to elective surgery
Term
Causes of hypermagnesium
Definition
Magnesium based antacids and laxatives, decreased renal excretion, newborns (mom on mag. drip), increased intake
Term
Symptoms of hypermagnesium
Definition
hyporeflexia (impairs acetylcholine release), weakness, sedation, vasodilation, bradycardia, heart block, myocardial depression, hypotension
Term
Anesthetic considerations for hypermagnesium?
Definition
EKG monitoring, potentiation of hypotension and negative inotropic effects with general anesthetic agents, increased NDMR effects.
Term
Treatment of hypermagnesium
Definition
Calcium + diuresis+ hydration. If acute may need dialysis
Term
Def. of hypothermia
Definition
temp <36 C.
Term
Metabolic rate decreases by what for each degree of C. reduction?
Definition
7%
Term
heat regulation center
Definition
hypothalamus
Term
this type of heat loss accounts for 60% of heat loss in the O.R.
Definition
Radiation
Term
Heat loss d/t air current or movement of a gas. Accounts for 15% of heat loss in O.R.
Definition
Convection
Term
Transfer of heat to adjacent molecules outside the body. Accounts for 3% of heat loss in O.R.
Definition
conduction
Term
How much heat is lost through evaporation? How does this increase?
Definition
As water evaporates it carries heat away with it. Accounts for 20% of heat loss in OR if pt is NOT sweating. Sweating increases heat loss x 10.
Term
What is the most critical factor influencing heat loss?
Definition
Temperature of O.R. room.
Term

Infant vs Adult temperature regulation

 

What predisposes infants to hypo/hyperthermia

Definition

 Body surface to weight ratio 2-2.5 times of adult

 

Small amts. subq fat

 

2-2.5 times minute ventilation

 

Up to 3 months do not shiver- rely on brown fat

 

Difficult dissipating heat d/t immature sweat glands

Term
Physiologic events @ <37 C
Definition
1) Arrhythmias 2) Resp. depression 3) Enzymatic and coag. factor dysfunction around 34 Degrees.
Term
Hypothermic events @ =< 33 degrees
Definition
1) bradycardia 2)Myocardial depression
3) VF 4) shivering stops
Term
Hypothermic events =< 30 degrees
Definition
1) Coma 2) Relative thrombocyopenia
Term
cardiovascular events with hypothermia
Definition
-vasonconstriction
-inc. SVR
-Vent. Arrhythmias
-Bradycardia
-Myocardial depression
Term
metabolic events assoc. w/ hypothermia
Definition
-Dec. metabolic rate
-decreased tissue perfusion
-acidosis
-hyperglycemia
Term
hematologic effects w/ hypothermia
Definition
-inc. viscosity
- left shift oxy hemo curve
-impaired coagulation
-thrombocytopenia
Term
Neurologic effects hypothermia
Definition
-dec. cerebral blood flow
-inc. cerebral vasc. resistance
-drowsiness
-confusion, lethargy, coma
Term
drug clearance effects of hypothermia
Definition
-dec. hepatic/renal blood flow
-dec. lung clearance
-reduction in required drug doses
Term
Anesthetic effects of hypothermia
Definition
-Decreased MAC
- Delayed emergence
Term
Shivering inc. heat production by how much?
Definition
100-300%
Term
shivering inc. O2 consumption by how much?
Definition
400-500%
Term
What happens if the room temp is less than 21 degrees?
Definition
All anesthetized pts become hypothermic
Term
Heated circuits should be kept below:
Definition
105 degrees F.
Term
Most commonly injured nerve in the OR?
Definition
ulnar nerve
Term
Factors that contribute to compartment syndrome
Definition
-prolonged OR time
-positioning
-Elevated extremity
-OR hypotension
-inc. age
-Extreme body habitus
Term
Compartment syndrome is usually associated with what?
Definition
Reperfusion injuries
Term
Positions w/ higher incidence of compartment syndrome?
Definition
lithotomy and lateral decubitus positions
Term
most commonly injured nerves in OR
Definition
ulnar, brachial plexus, peroneal
Term
Ulnar nerve damage incidence is higher in which gender.
Definition
Male
Term
Brachial Plexus injury occurs most frequently in this position
Definition
lateral position
Term
When are you most likely going to see spinal chord injury?
Definition
Vascular and thoracic surgery (procedures where blood supply to the chord is disrupted) , Sitting and prone positions.
Term
how does head flexion potentiate or lead to spinal chord injury?
Definition
Flexion forward (in sitting position) moves the chord anteriorly and stretches the chord. This also produces compression against the vertebrae can causes vessels to compress. This increases venous pressure in spinal chord and increases spinal chord pressure reducing perfusion.
Term
POVL is most often associated with?
Definition
-prone position- head down or tilt position.
Term
Besides Postition, what are other causes of POVL?
Definition
-emboli (cardio-pulmonary bypass)
-Glycine toxicity (TURP)
-Sickle cell disease increases risk for obstruction
Term
How much is FRC decreased from standing to supine in adult male?
Definition
800 ml
Term
What nerves can be damaged with crossed legs?
Definition
superficial peroneal nerve in dependent leg, sural nerve in superior leg.
Term
Ulnar nerve runs through this by the medial epicondyle of the humerous
Definition
cubital tunnel
Term
What is the best position for the breasts regarding prone position?
Definition
medial and cephalad within the frame
Term
Complications assoc. with prone position
Definition
-eye injuries
-blindness
-Venous air embolisms
-Macroglossia
-brachial plexus injury
Term
Most common eye injury assoc. w/ prone position? Most dangerous eye injury?
Definition
corneal abrasions,

Blindness
Term
Visual loss is assoc. w/ what?
Definition
Loss of perfusion through the retinal artery or damage to the optic nerve
Term
What 2 factors contribute to prone position blindness?
Definition
Global pressure and hypotension
Term
Pt's c/o parasthesias in arms after working w/ arms above their head- What is this and why is it important?
Definition
Thoracic Outlet syndrome. D/t compression of brachial plexus and subclavian vessels near first rib. Assess by having pt's clasp their hands behind occiput while being interviewed. If numbness or tingling- should not be placed in prone position with arms above head.
Term
What happens when you raise the legs for lithotomy position?
Definition
100-250 ml of blood per leg is reintroduced to the systemic circulation
Term
2 types of pts that tolerate lithotomy less than others:
Definition
CHF pts, pts w/ lung dx that reduces vital capacity (restrictive dx)
Term
What can happen when legs are lowered from lithotomy?
Definition
Hypotension d/t masked hypovolemia.
Term
most common nerve damage in Lithotomy position? What happens when this nerve is damaged?
Definition
peroneal nerve, Foot drop
Term
What is the proper placement of the axillary roll?
Definition
under the dependent shoulder slightly caudal to the axilla (not directly in the axilla)
Term
Most injuries in the lateral position?
Which one occurs most?
Definition
Ulnar nerve injuries (occurs the most), brachial plexus, Corneal abrasions/blindness
Term
In the sitting position, tell me about the flexion of the neck:
Definition
never to be flexed more than 2 finger breadths between the mandible and the sternum. Any more than this causes a reduction in venous return from head or lass of arterial flow to head.
Term
What do you do with the feet in long sitting position cases?
Definition
position them against a padded foot board at a 90 degree angle.
Term
Most frequent occurance with sitting position?
Definition
Hypotension
Term
Hemodynamic changes in sitting position/
Definition
reduction in venous return to heart, increased SVR in periphery. The more the sitting position the more profound the hemodynamic changes.
Term
MAP decreases by how much per elevation in sitting position?
Definition
.75 mmHG decrease in MAP per CM of elevation
Term
What is the most common complication of sitting position? What is the most dangerous?
Definition
Hypotension, Venous Air embolism
Term
Complications of Sitting position:
Definition
-hypotension
-Venous Air embolism
-Quadraplegia (stretching of spinal chord d/t extreme neck flexion)
-pneumocephalus (nitric oxide/nitrous exacerbates this)
Term
This nerve damage can occur with prone or supine position, causes wrist drop, "Saturday Night Palsy"
Definition
Radial nerve damage
Term
Tight wrist holders, deep antecubital sticks result in "ape hand" when this nerve is damaged:
Definition
median nerve
Term
Causes foot drop and loss of sensation over dorum of foot, damage can be d/t pressure on the lateral aspect of the knee
Definition
peroneal nerve damage
Term
Pressure on teh medial aspect of the knee resulting in loss of sensation to the medial thigh and leg:
Definition
saphenous nerve injury
Term
What can produce facial palsy? What nerve is damaged? What are the branches of this nerve?
Definition
Mask straps placed incorrectly lead to facial palsy d/t damage to the facial nerve. Facial nerve branches: temporal, zygomatic, buccal,mandibular, cervical (two zebras bit my cookies)
Term
in infants nose is responsible for how much airway resistance?
Definition
25%
Term
Why are infants obligate nose breathers? When does this switch?
Definition
1) motor and sensory pathways of the oropharynx do not coordinate well with resp.
2) larynx is higher in the neck, oropharyngeal structures are closer together during resp.-- so the tongue rests against the roof of the mouth resulting in airway obstruction. The switch takes place at 3-5 months.
Term
What is the length of the carina to the vocal chords in full term infant?
Definition
4 cm (therefore easy to mainstem, easy to extubate)
Term
Children: Teeth in/ Teeth out
Definition
in: 6 months out: 6 years
Term
Narrowest opening of the infant/small child airway?
Definition
cricoid cartilage
Term
infants larynx sits where? how about adults?
Definition
infants: c3-c4
adults: c5-c6
Term
What difference in infant/small child's vocal chords vs adults can make intubation (especially nasal) more difficult?
Definition
Lower attachement anteriorly vs. posteriorly. Tip of tube gets caught in the anterior commissure or space where the chords attach anteriorly. In adults the chords attach nearly perpendicular to the glottic opening.
Term
Airway position for children < 2 years?
Definition
neutral posiion. Place child on folded blanket or towel. (huge cranium/occiput forces head forward without towel)
Term
position for child > 2 years for airway positioning?
Definition
towel placed under head, sniffing position
Term
What's up with mainstem bronchi in kids?
Definition
branch at 55 degree angles making mainstem intubation of either bronchus a possibility
Term
How do you size and length ETT tubes for infants/children?
Definition
Based on internal diameter.
1) Size= Age+16/4

2) length=age/2+12
length calculates teh distance from the alveolar ridge to mid trachea. Length in newborn is 10 cm. 6mo-1yr=11-12 cm. The rest of lengths are accurate with formula
****************************************when choosing a cuffed size go 1/2 size down*********************
Term
What is the age cutoff for cuffed/uncuffed ETT tubes?
Definition
8 years old
Term
ETT should have how much water leak in infants/ children?
Definition
15-20 cm
Term
How do you size premie tubes?
Definition
start with 2.5 for i.d. length = 7 cm for first 1000gm. (add one cm for each kg to max of 10 cm)

3.0 id for 1000-2500gms
3.5 id for > 2500 gms
Term
2 things that are important about sx an infant/ small child
Definition
1)Sx should be low pressure < 50cm h2o

2) Do not touch carina
Term
How do you size sx catheters?
Definition
Size of ETT x 2 = French size that will fit through ETT
Term
What can happen if your ETT is too tight in the child's airway? What do you do about it?
Definition
Airway edema which manifest as post extubation croup and stridor. Decadron can be given and/or racemic epinepherine aerosol treatements.
Term
Why is the PaCO2 and PaO2 of the newborn lower than that in an adult?
Definition
Hypoxia breathing regulation is not fully developed in infants. Much lower than adults until the end of the first year.
Term
What do premature infants often experience as a result of underdeveloped breathing regulation?
Definition
resp. arrest.
Term
How do infants react to hypoxia?
Definition
increasing minute volume follow by an episode of hypoventilation or apnea
Term
What can cause hypoventilation in the infant?
Definition
Hypothermia or hypoglycemia
Term
What is the hering-breuer reflex?
Definition
Neonates/ small children have mechanoreceptors r/t compliance of lungs. When overstretched with large tidal volumes or deep inspiration there is an abruption in the inspiratory phase. This mechanism is thought to protect from resp. fatigue caused by ineffective muscle work and volutrauma.
Term
high airway resistance and low lung compliance in the infant leads to what?
Definition
rapid- sinusoidal resp. rate with no expiratory pause.
Term
What is the oxygen consumption for a fetus? newborn? Adult?
Definition
Fetus: 4.5 ml/kg/min

At Birth: 7 ml/kg/min

Adult: 4-5 ml/kg/min
Term
Oxygen consumption is higher in the infant because:
Definition
1. 35% of the caloric intake is used for growth. An infant will double their weight in 6 months and triple their weight in 1 year.

2. Gastrointestinal function and breathing have started after birth increasing demand

3. Temperature regulation begins after birth.
Term
FRC for: 5kg child, 10 kg child, 20 kg child,
Definition
10ml/kg, 15 ml/kg, 30 ml/kg
Term
RR of newborns, infants, small children, school aged children
Definition
40-60(1-28 days), 30-60(up to 1 year), 30-40(2-5 years), 12-20 (6-14 years)
Term
What consists of lipoproteins made of lecithin manufactured by Type 2 alveolar cells?
Definition
Surfactant
Term
if I treat a neonate with surfactant what can I expect and in what time frame?
Definition
increase in FRC within 6-12 hours
Term
True or false:
Lack of surfactant is the major cause of RDS after 35-36 weeks of gestation:
Definition
False. Surfactant production starts at 24 weeks and can be detected in amniotic fluid between 30-36 weeks.
Term
What is the best way to wreck surfactant?
Definition
Too much or too little O2, aspiration, too aggressive ventilation (too high tidal volumes) acidosis, temperature
Term
True or false:
Inhalation agents have little effect on surfactant production.
Definition
true
Term
What increases sufactant production in the infant?
Definition
-Steroid admin to mom
-use of thyroxine
-cortisone
-heroin
Term
Why are kids more susceptible to hypoxia?
Definition
high metabolic rate, less FRC, higer O2 consumption
Term
How much volume do we use to ventilate infants? premies?
Definition
infants: 5-7 mg/kg

Premies: 4-6 ml/kg

Gayle states "aim for 5 ml/kg"
Term
What kind of bag do we ventilate kids with?
Definition
50 ml/kg, better to go a little bigger than what you need, low resistance, minimal dead space
Term
Newborn cardiac output vs adult?
Definition
newborn: 300-400 ml/kg/min which decreases in first few months to 150-200 ml/kg/min

Adult: 70-80ml/kg/min
Term
Cardiac output in the infant is more heavily weighted on ________. Why?
Definition
Increasing heart rate. Newborn has less contractile tissue (30%) vs. adult (60%) Infants ventricle is stiff and less compliant thus reducing preload.
Term
hemoglobin F is replaced by hemoglobin A in what time frame?
Definition
3-6 months
Term
normal hgb levels in newborn infant?(full term)
Definition
14-20 gm/dL
Term
Hemoglobin of infant @ 9-12 weeks (2-3 months)up to 2 years?
Definition
gradual decline from newborn levels to 10-11 g/dL with a gradual gain to 11.5-12 g/dL until 2 years of age.
Term
how is anemia in the infant defined? how is anemia in the infant at 3 months defined?
Definition
1)Hgb <13 g/dl 2) Hgb <10 g/dl
Term
newborn kidneys- what's the dealio?
Definition
GFR at birth is 15-30% normal, low GFR d/t decreased systemic presure, increased renal resistance, and nephron immaturity.
-obligate sodium excreters (even in dehydration scenarios where RAAS system kicks in to conserve Na+ the renal tubules are immature and will continue sodium loss)
Term
When does GFR become fully functional in kids?
Definition
1 year, yet the ability to concentrate urine does not become fully functional until 2-3 years of age.
Term
The primitive moro response and the grasp reflex are a demonstration of?
Definition
central nervous system immaturity at birth
Term
When is nerve myelination complete?
Definition
Age 3
Term
Where does the spinal chord end in a newborn?
Definition
L3 (vs L1 in adult)
Term
Never use hypertonic sodium bicarb or dextrose in a newborn-- why?
Definition
BBB is imcomplete exposing the brain to substances that would not normally cross. Cerebral arteries are very fragile exposing the infant to intracranial hemmorhage. Hypertonic solutions damage fragile vessels
Term
Hepatic system functionality at birth, 1 month, and 1 year
Definition

birth: sulfonation is functioning, conjugation at birth

 

 acetylation, glycination, and glucoronidation are immmature

 

functioning 1 month: cytochrome P450 system working 1 year: all biotransformation rxns are mature

 

  1.   Newborn has high hct.  These RBC's break down.  Immature liver can not fully conjugate the bilirubin with glucoronic acid for excretion into the bile.
  2. Bilirubin binds to albumin
  3. Many of our drugs bind to albumin (this leads to more unbound bilirubin)
  4. Unbound unconjugated bilirubin can cross physiological membranes. 
  5. Bilirubin in the basal ganglia causes kernicterus, a form of bilirubin driven brain damage.
  6. Crossing of bilirubin leads to jaundice
Term
Results of cold stress on the infant
Definition
increased metabolic rate, decreased supply to tissue (vasoconstriction), decreased uptake (pulmonary vasoconstriction)
Term
how might an infant react to a temp less than 35.5?
Definition
with apnea. Therefore leave intubated if this cold until warmed.
Term
Where should esophageal monitoring be done in the child and why?
Definition
distal portion of esophagus because cool gases can affect results as well as thin abdominal skin of child.
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