Term
| Only ___% of the RV output crosses the pulmonary circulation |
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Definition
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Term
| What drug can be used to reduce and right to left shunt? |
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Definition
| Ketamine. Ketamine reduces pulmonary vascular resistances and increases SVR thus making less R-L and more L-R (improves cyanosis) |
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Term
| The fetal circulation behaves like a______circuit |
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Definition
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Term
| the first breath of air and expansion of the newborn lungs, causes increased Pa02, decreased PaCO2, and decreased pulmonary PVR. This is known as? |
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Definition
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Term
| What casues the closure of the foramen ovale? When does this occur? |
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Definition
| LVED pressure creates backpressure to prevent blood from flowing into the left atrium forming a functional closure. It takes months for an acutal anatomic closure and in 25% of adults it will remain open |
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Term
| The ductus arteriosus is functionally closed in 98% of term infants by day? What causes the closure? |
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Definition
| arterial oxygen tension and reduction in prostagladnins. 4 days of life. Anatomic closure occures 2-3 weeks. |
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Term
| The ductus venosus closes d/t the ligation of the umbilical vein and drop in portal pressure. This occurs? |
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Definition
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Term
| The neonatal heart has less organized myocytes. Contractile elements consitute 30% vs. 60% in adults...making the baby more reliant on _______ influx to initiate & terminate a contraction |
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Definition
| calcium; They have lower SBP & DBP d/t myocaridal cell compsoition and ca transport. CO is RATE dependent since SV can not be increased like adults |
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Term
| The Cardiac output in neonates is increased d/t? |
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Definition
| high metabolic demands of the infant |
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Term
| The sympathetic system reaches maturity when? The parasysmpathetic by when? |
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Definition
| SNS early infancy; PNS within a few days of birth. This imbalance explains why they are more vunerable to vagal stimuation. |
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Term
| the immature neonateal heart is sensitive to pharmacolgic agents that produce ______ and_____ effects |
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Definition
| negative inotropic and chronotropic effects |
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Term
| Left to right shunts add a volume load to the heart. Any structural defect that diverts the LV ouput the the pulmonary circulation triggers inc. catecholamines, renin, angiotensin and vasoconstrict to compensate for lost systemic flow. What happens to Stroke volume? |
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Definition
| increases d/t volume expansion and dilating the LV |
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Term
| _____% of down sydndrome children have CHD. 50% of the defects are? |
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Definition
| endocardial cushion defects commonly known as ASD. The remaining are VSD, Tetralogy of Fallot, and PDA |
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Term
| What disease is an autosomal dominal connective tissue disease that causes dilation of the cardiac valves resulting in regurgitation? What percent of kids end up the MV dysfunction. |
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Definition
| Marfan Disease. 68% end up with mitral valve dysfunction and are predisposed to aortic aneurysm |
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Term
| An acute febril inflammatory disease that leaves residual aneurysms? |
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Definition
| Kawasaki dz. 40% of the kids will develop acquired heart dz. 20% will develop coronary aneurysms causing MI and death in 3-4% |
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Term
| What is the MOST common CHD in children? |
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Definition
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Term
| What is ONE OF the most common cogenital cardiac anomalies in children? |
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Definition
| ASD, normal function after repair. |
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Term
| With PDA what is one of the consequences of large left to right shunts? |
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Definition
| increased pulmonary blood flow and LV volume overload |
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Term
| What CHD causes obstruction to the systemic blood flow and increased left verticular afterload? |
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Definition
| coarctation of the aorta. Causes LV hypertropy in older kids. Angioplasty may be effectinve. May be associated with other heart abnmormalities. |
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Term
| Name the MOST common cyanotic cardiac lesion. |
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Definition
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Term
| What four characteristics are assoc. w/ Tetralogy of Fallot? |
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Definition
| RV outflow obstruction, Intraventricular communication, RV hypertropy, Aortic override. |
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Term
| treatment for Tetralogy spells |
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Definition
| increase blood volume, inspired O2, and SVR. DON"T let BP drop |
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Term
| which emergency drugs should you have available for kids w/ severe cardiac dz? |
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Definition
| atropine, epinephrine, CaCl, Lidocaine, Succinylcholine |
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Term
| IV induction is preferred in children w/ severe CV disease. L-R shunts may_________the effect of the drug |
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Definition
| slow. Right to left shunts speeds IV induction |
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Term
| Inhalational induction with children with severe CV disease may be delayed. |
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Definition
| Low Cardiac output may speed induction d/t less anesthetic being removed from the pulmonary circulation. |
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Term
| A child wiht an upper airwar obstruction may exhibit inspiratory ______, tachypnea, ________retractions, agitation, cyanosis, and tachycardia. |
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Definition
| stridor, intercostal retractions. Give Oxygen, keep them calm, get X-ray to determine the cause. DON'T bother w/ ABG...it will just irritate the kid...use the puse ox. Don't try IV until after induction. If an emergency have all equipment ready and SURGEON in the room in case a surgical airway is needed. |
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Term
| A child with a compromised airway MUST maintain _________ ventilations |
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Definition
| spontaneus. If obstructing apply 5-10cmH20 pressure and assist child breathing. Inhalational induction should be slow and the child should be deep before layngoscopy to avoid larngospasm |
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Term
| Epiglottitis is a _________ infection. Thanks to the H.influenzae vaccination, strep, staph, and Candida are most freq causes. Effects kids ____-____y/o |
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Definition
| life threatening. Ages 1-7 y/o. |
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Term
| Which airway obstruction does the child present in tripod position? |
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Definition
| epiglottitus. Upper airway obstruction, drooling, difficulty swallowing. Go directly to OR...don't let ER personel laryngoscopy d/t trauma to epiglottis. Radiographic examination is NOT necessary. Perform controlled INHALATIONAL INDUCTION, try not to touch the epiglottis w/ the scope. Use a 0.5 mm smaller tube d/t edema. Draw Blood cultures and treat appropriately. Kid stays intubated 24-48 hrs until +leak check and no edema |
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Term
| Laryngotracheaobronchitis is common in kids 6 months to 6 years old. Life threatening obstruction caused by a virus. Presents with low grade fever and _______cough. Treat with? |
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Definition
| croupy; treat w/ cool mist and O2. To relieve obstruction use nebulized racemic epi 0.25-0.5ml in 2ml of saline repeat q4hrs. Intubation MAY be necessary if treatment doesn't improve obstruction |
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Term
| Foreign body aspiration. Wheezing in the non asthmatic child, removed immedidately in the OR. CXRAY may be helpful but ONLY if the kid is stable. __________respirations during_______inducation is preferred. |
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Definition
| spontaneous; during inhalational induction. Bronchoscopy will be done to remove the object from the aiwary. |
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Term
| Lower airway obstruction i.e. asthma is characterized by wheezing or dyspnea associated with narrowing of the intrpulmonary airways. Most _______wheezes |
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Definition
| expiratory. Obstruction leads to airtrapping, treat w inhaled steriods for long term control. For acute treatment, B-agonish, corticosterios, and methylxathies i.e. theophylline |
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Term
| Asthma pts. avoid________releasing agents. RSI if full stomach. Be careful with cricoid pressure could make bronchospaspm worse. Give opiods and lidocaine, which IA preferred? Glyco to dry secretions. |
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Definition
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Term
| Asthma pt. may need higher airway pressures and longer_______time. If wheezing persists or occurs during surgery rule out________. |
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Definition
| expiratory time. Rule out mechanical problems with the tube, cuff, kinking etc... |
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