Term
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Definition
| Newborn who has not reached term |
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Term
| Newborn (definition in days) |
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| What should you consider when setting up your room for a teenager, aged 14 years old or greater? |
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Definition
| Size can vary greatly, so prepare the room as you would for the pediatric population, but have additional sized equipment available if the kiddo is large. |
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Term
| The nose is responsible for what percentage of total airway resistance in infants? |
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Definition
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Term
| The nose is responsible for what percentage of total airway resistance in adults? |
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Definition
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Term
| Are infants obligate nose breathers, or mouth breathers? |
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Definition
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Term
| What happens when you block an infants nose (obstruct the anterior or posterior nares)? |
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Definition
| respiratory distress or asphyxia |
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Term
| Why are infants obligate nose breathers (2 reasons)? |
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Definition
1) The motor/sensory pathways of the oropharynx do not coordinate well with respiration
2) The larynx is higher in the neck and the oropharyngeal structures are closer together during respiration. And the tongue rests against the roof of the mouth resulting in oral airway obstruction. |
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Term
| At what age do infants switch to mouth breathing (when elongation of the larynx occurs along with the coordination of respiration and oropharyngeal structures)? |
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Definition
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Term
| What treatment could greatly hinder an infants ability to breath? |
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Definition
| Placement of a nasogastric tube. |
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Term
| Will overextending an infant's neck improve or obstruct your view during intubation? |
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Definition
| It will obstruct your view? |
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Term
| T/F: The infants tongue is small in proportion to the oral cavity |
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Definition
| False: The infant's tongue is large in proportion to the oral cavity |
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Term
| What is the difference between the neck/trachea of an infant compared to an adult? |
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Definition
| The neck/trachea are shorter in an infant. |
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Term
| What is the distance between the carina and the vocal cords in a full term infant? |
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Definition
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Term
| At what age do infants begin to develop teeth? |
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Definition
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Term
| At what age do children start to lose teeth? |
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Definition
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Term
| When is the CRNA most a risk for knocking a tooth out of the mouth and into the airway or esophagus? |
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Definition
| During Direct Visual Laryngoscopy |
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Term
| So when should you remove lose teeth from a child? |
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Definition
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Term
| Who should you save the teeth for? |
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Definition
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Term
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Definition
| Surgically removed tonsils |
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Term
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Definition
| Tonsils hidden within tonsil pillars |
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Term
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Definition
| Tonsils extending to the pillars |
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Term
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Definition
| Tonsils are beyond the pillars |
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Term
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Definition
| Tonsils extend to midline (sometimes called kissing tonsils) |
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Term
| When do adenoids shrink and disappear? |
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Definition
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Term
| What provides a "fantastic opportunity for soft tissue airway obstruction, especially after induction"? |
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Definition
| The tonsils and adenoids. |
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Term
| Does an infant's larynx sit higher or lower in the neck than an adult? |
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Definition
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Term
| In an infant, the larynx sits at the level of what vertabrae? |
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Definition
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Term
| In an adult, the larynx sits at the level of what vertabrae? |
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Definition
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Term
| Is it correct to say that the larynx in an infant is positioned "more anterior"? |
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Definition
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Term
| What are correct terms for stating the position of the larynx in an infant? |
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Definition
-rostral
-superior
-cephalad |
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Term
| How does the epiglottis of an infant differ from that of an adult? |
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Definition
-it has an omega shape in an infant and a V or teardrop shape in an adult
-it is larger in an infant than in an adult |
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Term
| How is the cricothyroid membrane differ in an infant vs an adult? |
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Definition
| It is a slit in an infant, while it is a space in the adult |
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Term
| Due to the large, omega shaped epiglottis in an infant, what type of blade tend to work best for intubation? |
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Definition
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Term
| What is the narrowest opening of an infant's larynx? |
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Definition
| The cricoid cartilage, which is a complete ring. |
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Term
| Why should an ETT never be forced beyond the cords in an infant/small child? |
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Definition
| Because the larynx takes on a funnel shape. |
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Term
| T/F: in an infant/small child, the vocal cords attach higher anteriorly vs posteriorly |
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Definition
| False, the vocal cords attach lower anteriorly vs posteriorly |
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Term
| When nasally intubating an infant/small child, where is the tip of the ETT likely to get caught? |
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Definition
| In the anterior comissure or space where the cords attach anteriorly |
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Term
| The larger head of an infant/small child compared to an adult, causes what to happen to head positioning and airway axes? |
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Definition
1) the head is forced into a flexed position
2) the airway axes are skewed |
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Term
| What is the proper head position for intubation/alignment of airways in a child less than 2 years of age? |
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Definition
Neutral Head Position
-Accomplished by placing the pt on a folded blanket or towel |
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Term
| What is the proper head position for intubation/alignment of airways in a child less than 2 years of age? |
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Definition
The sniffing position
- Accomplished by putting a small towel underneath the head |
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Term
| Pediatric ETT size calculation |
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Definition
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Term
| Pediatric ETT Length (depth) Calculation |
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Definition
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Term
| When setting up for a peds case, you should have the calculated tube size on your table top and what else? |
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Definition
| A 1/2 size up and a 1/2 size down |
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Term
| The length (depth) calcuation covers the distance from _____ to _____? |
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Definition
| The alveolar ridge to the mid trachea |
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Term
| According to this lecture, what is the "definitive way to determine if the ETT is in the proper position"? |
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Definition
| Listen to bilateral breath sounds |
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Term
| If you need a cuffed ETT, how should you pick the size? |
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Definition
| Use the size formula and go a 1/2 size down. |
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Term
| What is the ETT depth for newborns? |
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Definition
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Term
| What is the ETT depth for 6 months to 1 year? |
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Definition
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Term
| Does the ETT size formula give you the external or internal diameter of the ETT? |
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Definition
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Term
| Why do most texts recommend using an uncuffed ETT? |
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Definition
1) b/c if it has an appropriate air leak it puts minimal pressure on the internal cricoid cartilage and potentially reduces risk for postextubation croup
2) you can use a larger diameter tube which results in less airway resistance. |
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Term
| Advantages of the Cuffed ETT |
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Definition
1) No need for repeated DVL to place a properly fitting tube
2)reduced subglottic pessure
3) reduced OR pollution
4) reduced aspiration risk
5) accurate ventilator volume measurement
6) can deliver high airway pressures in pts with sever restrictive lung disease |
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Term
| How should the cuff be inflated? |
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Definition
| Minimally (if at all) to create a proper seal, while still allowing an appropriate air leak (remember, she said to take the plunger off the syringe and let air go in) |
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Term
| If you are running nitrous, what can happen to your cuff? |
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Definition
| Nitrous can cross into the cuff and create insufflation |
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Term
| You should consider an uncuffed ETT in what age group? |
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Definition
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Term
| An ETT should have what amount of an air leak? |
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Definition
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Term
| If an ETT won't go in further, should you force it? |
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Definition
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Term
| Is it ever ok to have no air leak with an uncuffed ETT or a cuffed tube with a deflated cuff? |
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Definition
| No, you should always have an air leak with an uncuffed tube or a cuffed tube without air in the cuff. |
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Term
| The PICU prefers what type of ETT? |
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Definition
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Term
| The NICU prefers what type of ETT? |
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Definition
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Term
| What size and type of ETT should you use for an infant weighing 1000gms or less? |
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Definition
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Term
| Depth calculation for infant weighing 1000gms of less |
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Definition
| 7 cm for the first 1000gms + 1cm for each kg up to max of 10cm |
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Term
| What size and type of ETT should you use for an infant weighing 1000-2500gms? |
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Definition
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Term
| What size and type of ETT should you use for an infant weighing >2500gms? |
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Definition
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Term
| Laryngoscope Blade Selection for a Preemie |
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Definition
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Term
| Laryngoscope Blade Selection for a Full Term Infant |
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Definition
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Term
| Laryngoscope Blade Selection for a Term Infant-2 years |
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Definition
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Term
| Laryngoscope Blade Selection for 2-6 years |
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Definition
Miller 1
Wis-Hipple 1.5
Mac 1 or 2 |
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Term
| Laryngoscope Blade Selection for 6-10 years |
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Definition
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Term
| Laryngoscope Blade Selection for >10 years |
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Definition
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Term
| Suction Catheter Size Formula |
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Definition
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Term
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Definition
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Term
| Is it ok to use a hard yaunker to PO suction infants and small children? |
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Definition
| No, use a soft tube for PO suction |
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Term
| Is it okay to jam the suction tube into the carina when suctioning an infant or small child? |
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Definition
| No! Don't touch that carina! |
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Term
| Why is airway edema less tolerated by a child than an adult? |
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Definition
| They have smaller airways to begin with, so "even a small amount of subglottic edema" can be bad and can occlude the airway. |
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Term
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Definition
R= (8 * n * l)/ pie * R^4
R is resistance
r is radius
n is viscosity
l is length |
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Term
| What two drugs can be given to reduce edema and help with post-extubation croup or stridor? |
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Definition
| Decadron and racemic epinephrine |
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Term
| How long does it take for decadron to reduce edema? |
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Definition
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Term
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Definition
| 2.25% solution, 0.5-1ml in 2-3ml normal saline and nebulized |
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Term
| How often can you repeat the dose of racemic epinephrine? |
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Definition
| You can repeat the dose 20 minutes after the first dose, and then every 2-4 hours as needed. |
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Term
| According to Poiseuille's Law, when the radius is halved, what happen to resistance? |
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Definition
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Term
| Grade 1 Subglottic Stenosis |
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Definition
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Term
| Grade 2 Subglottic Stenosis |
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Definition
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Term
| Grade 3 Subglottic Stenosis |
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Definition
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Term
| Grade 4 Subglottic Stenosis |
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Definition
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Term
| Treatment for congenital subglottic stenosis |
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Definition
| Depends on severity, ranges from clinical observation to tracheostomy with or without tracheal dilation |
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Term
| In congenital subglottic stenosis, airway anatomy is generally normal until what anatomical structure? |
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Definition
| The vocal cords, after this point, the trachea begins to narrow. |
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Term
| What part of breathing regulation in newborns is not fully developed? |
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Definition
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Term
| How do infants react to hypoxia? |
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Definition
| By increasing minute volume followed by an episode of hypoventilation or apnea. |
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Term
| What two things will produce hypoventilation in an infant? |
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Definition
| Hypoglycemia and Hypothermia |
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Term
| Infants and small children have _____ chest walls and ________ lung tissue |
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Definition
| compliant chest walls and non-compliant lung tissue |
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Term
| What is the most well known mechanoreceptor related to lung compliance in infants and small children? |
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Definition
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Term
| The Hering-Breuer reflex is especially noted in what age? |
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Definition
| The premature neonate (32-38 weeks gestation) |
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Term
| Explain the Hering-Breuer Reflex |
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Definition
- A large tidal volume or deep inspiration causes over stretch or receptors resulting in an abruption of the inspiratory phase (apnea).
-protects from muscle fatigue d/t ineffective muscle work and volutrauma. |
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Term
| What muscle does nearly all the work of breathing for the infant? |
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Definition
| Diaphragm, so "abdominal hindrances can lead to insufficient spontaneous breathing" |
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Term
| Why is the "ventilatory pump" less efficient in young children? |
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Definition
-unstable chest wall
-diaphragm easily tires (has fewer type I fibers) |
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Term
| Describe the respiratory pattern of a child |
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Definition
| Sinusoidal with no expiratory pause |
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Term
| T/F: The ribs of an infant are horizontal and the ribs of an adult are slanted (diagonal) |
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Definition
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Term
| Muscle fibers that are slow twitch, have many mitochondria, and are fatigue resistant |
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Definition
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Term
| Muscle fibers that are fast twitch, have fewer mitochondria, and are less energy efficient |
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Definition
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Term
| Newborns have what percentage of slow, type 1 muscle fibers in their diaphragm? |
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Definition
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Term
| Preemies have what percentage of slow, type 1 muscle fibers in their diaphragm? |
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Definition
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Term
| Adults have what percentage of slow, type 1 muscle fibers in their diaphragm? |
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Definition
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Term
| Newborns have what percentage of slow, type 1 muscle fibers in their intercostal muscles? |
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Definition
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Term
| Preemies have what percentage of slow, type 1 muscle fibers in their intercostal muscles? |
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Definition
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Term
| Adults have what percentage of slow, type 1 muscle fibers in their intercostal muscles? |
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Definition
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Term
| In children, how does FRC, resp. rate, and metabolic oxygen consumption compare to that of an adult? |
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Definition
- less FRC
- higher RR
- higher metabolic O2 consumption |
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Term
| In children, the trachea, bronchi, and bronchiole structures are soft and pliable, so what happens with negative pressure in deep or forced spontaneous inspiration? |
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Definition
| These structures collapse |
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Term
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Definition
| 4.5 ml/kg/min (nearly the same as adult) |
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Term
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Definition
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Term
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Definition
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Term
| Why is the O2 consumption rate higher in the infant? |
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Definition
1) 35% of calorie intake is used for growth
2) GI function and Breathing begin after birth
3) Temperature regulation begins after birth |
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Term
| Where dose most of the airway resistance occur in infants? |
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Definition
| In the Bronchial and Small Airways d/t the small size |
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Term
| Why do infants have a lack of negative pressure generated to take a breath? |
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Definition
1) noncompliant airways
2) compliant chest walls
3) immature musculature |
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Term
| Parenchymal changes in infants that further reduce compliance |
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Definition
1) bronchial pneumonia
2) pulmonary edema
3) ARDS
4) Fibrosis |
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Term
| Examples of Reduced Volume in infants that further reduce compliance |
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Definition
1) Pneumothorax
2) Raised Diaphragm |
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Term
| Functional surfactant disorders in infants that further reduce compliance |
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Definition
1) Pulmonary Edema
2) Atelectasis
3) Aspiration
4) RDS/ARDS |
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Term
| Tidal volume for newborn to 12 years |
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Definition
|
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Term
| surfactant is produced by what cells |
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Definition
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Term
| surfactant is made up of what? |
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Definition
| lipoproteins that are made of lecithin |
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Term
| When does surfactant production begin? |
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Definition
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Term
| When does surfactant release into the amniotic fluid increase? |
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Definition
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Term
| What infants are at risk for RDS and atelectasis due to a lack of surfactant? |
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Definition
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Term
| At what age gestation does incidence of RDS due to lack of surfactant decrease? |
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Definition
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Term
| What other factors impact surfactant production? |
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Definition
Acidosis
Hypo/hyperoxia
Temp
Inhalation Agents |
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Term
| Synthetic Surfactant increases FRC in how many hours after administration? |
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Definition
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Term
| How is synthetic surfactant administered? |
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Definition
| Directly into the lungs via an ETT |
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Term
| What can cause surfactant to be destroyed? |
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Definition
1) 100% FiO2 delivery
2) Aspiration
3) Too aggressive ventilation (too high tidal volumes- volutrauma/barotrauma |
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Term
| What causes increased surfactant production? |
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Definition
1) steroids given to mom prior to delivery
2) thyroxine
3) cortisone
4) heroin |
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Term
| How quickly can hypoxia occur in an infant? |
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Definition
10-20 seconds following apnea, vs 2-3 minutes in an adult
(they have very little respiratory reserve) |
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Term
| Do kids or adults tolerate hypoxia better? |
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Definition
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Term
| How long can a newborn survive without respiration immediately after birth? |
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Definition
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Term
| Prolonged hypoxia leads to lesions where, and what type of damage occurs first? |
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Definition
| In the thalamus and brain stem with MOTOR DAMAGE OCCURING FIRST (think cerebral palsy) |
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Term
| Infants tend to _____ rapidly, and _____ rapidly once ventilation is adequate. |
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Definition
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Term
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Definition
1) long ETT adds to airway resistance
2) smaller diameter than actual airway
3) can produce subglottic edema
4) Higher risk for post op pneumonia d/t thickened secretions/atelectasis from air not being filtered/humidified by the nasal/oropharynx
5) reduced cilia movement
6) dry, cold air/gas irritates the airway and can lead to bronchospasm and decrease temp. |
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Term
| Sign of increased work of breathing in kids |
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Definition
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Term
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Definition
1) suprasternal
2) intercostal
3) substernal
4) subcostal |
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