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
|
|
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
|
|
Term
| In a child 3 ml/kg of PRBCs will raise the Hgb/ hct by how much? |
|
Definition
|
|
Term
| Which plasma proteins and clotting factors does FFP contain? |
|
Definition
| All of them, but factors 5 and VIII are very labile. |
|
|
Term
|
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
|
|
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
|
|
Term
| How long to transfused plts survive? |
|
Definition
|
|
Term
| How much plasma is in a unit of platelets? |
|
Definition
|
|
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
|
|
Term
| How do you raise the plt count by 50,000 mm3 in older children? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
|
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
|
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
|
|
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
|
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
|
|
Term
| What is the normal phosphorus level? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
Term
| What is the normal magnesium level? |
|
Definition
| 1.5-2.1 meq/L or 1.7-2.4 mg/dl |
|
|
Term
|
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
|
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
|
Definition
|
|
Term
| Metabolic rate decreases by what for each degree of C. reduction? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| this type of heat loss accounts for 60% of heat loss in the O.R. |
|
Definition
|
|
Term
| Heat loss d/t air current or movement of a gas. Accounts for 15% of heat loss in O.R. |
|
Definition
|
|
Term
| Transfer of heat to adjacent molecules outside the body. Accounts for 3% of heat loss in O.R. |
|
Definition
|
|
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
|
|
Term
| shivering inc. O2 consumption by how much? |
|
Definition
|
|
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
|
|
Term
| Most commonly injured nerve in the OR? |
|
Definition
|
|
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
|
|
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
|
|
Term
| Brachial Plexus injury occurs most frequently in this position |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
| Tight wrist holders, deep antecubital sticks result in "ape hand" when this nerve is damaged: |
|
Definition
|
|
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
|
|
Term
| Pressure on teh medial aspect of the knee resulting in loss of sensation to the medial thigh and leg: |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
Term
| ETT should have how much water leak in infants/ children? |
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Definition
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Term
| How do you size premie tubes? |
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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 |
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Term
| 2 things that are important about sx an infant/ small child |
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Definition
1)Sx should be low pressure < 50cm h2o
2) Do not touch carina |
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Term
| How do you size sx catheters? |
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Definition
| Size of ETT x 2 = French size that will fit through ETT |
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Term
| What can happen if your ETT is too tight in the child's airway? What do you do about it? |
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Definition
| Airway edema which manifest as post extubation croup and stridor. Decadron can be given and/or racemic epinepherine aerosol treatements. |
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Term
| Why is the PaCO2 and PaO2 of the newborn lower than that in an adult? |
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Definition
| Hypoxia breathing regulation is not fully developed in infants. Much lower than adults until the end of the first year. |
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Term
| What do premature infants often experience as a result of underdeveloped breathing regulation? |
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Definition
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Term
| How do infants react to hypoxia? |
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Definition
| increasing minute volume follow by an episode of hypoventilation or apnea |
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Term
| What can cause hypoventilation in the infant? |
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Definition
| Hypothermia or hypoglycemia |
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Term
| What is the hering-breuer reflex? |
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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. |
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Term
| high airway resistance and low lung compliance in the infant leads to what? |
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Definition
| rapid- sinusoidal resp. rate with no expiratory pause. |
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Term
| What is the oxygen consumption for a fetus? newborn? Adult? |
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Definition
Fetus: 4.5 ml/kg/min
At Birth: 7 ml/kg/min
Adult: 4-5 ml/kg/min |
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Term
| Oxygen consumption is higher in the infant because: |
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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. |
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Term
| FRC for: 5kg child, 10 kg child, 20 kg child, |
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Definition
| 10ml/kg, 15 ml/kg, 30 ml/kg |
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Term
| RR of newborns, infants, small children, school aged children |
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Definition
| 40-60(1-28 days), 30-60(up to 1 year), 30-40(2-5 years), 12-20 (6-14 years) |
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Term
| What consists of lipoproteins made of lecithin manufactured by Type 2 alveolar cells? |
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Definition
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Term
| if I treat a neonate with surfactant what can I expect and in what time frame? |
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Definition
| increase in FRC within 6-12 hours |
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Term
True or false:
Lack of surfactant is the major cause of RDS after 35-36 weeks of gestation: |
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Definition
| False. Surfactant production starts at 24 weeks and can be detected in amniotic fluid between 30-36 weeks. |
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Term
| What is the best way to wreck surfactant? |
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Definition
| Too much or too little O2, aspiration, too aggressive ventilation (too high tidal volumes) acidosis, temperature |
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Term
True or false:
Inhalation agents have little effect on surfactant production. |
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Definition
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Term
| What increases sufactant production in the infant? |
|
Definition
-Steroid admin to mom
-use of thyroxine
-cortisone
-heroin |
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Term
| Why are kids more susceptible to hypoxia? |
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Definition
| high metabolic rate, less FRC, higer O2 consumption |
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Term
| How much volume do we use to ventilate infants? premies? |
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Definition
infants: 5-7 mg/kg
Premies: 4-6 ml/kg
Gayle states "aim for 5 ml/kg" |
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|
Term
| What kind of bag do we ventilate kids with? |
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Definition
| 50 ml/kg, better to go a little bigger than what you need, low resistance, minimal dead space |
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Term
| Newborn cardiac output vs adult? |
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Definition
newborn: 300-400 ml/kg/min which decreases in first few months to 150-200 ml/kg/min
Adult: 70-80ml/kg/min |
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Term
| Cardiac output in the infant is more heavily weighted on ________. Why? |
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Definition
| Increasing heart rate. Newborn has less contractile tissue (30%) vs. adult (60%) Infants ventricle is stiff and less compliant thus reducing preload. |
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|
Term
| hemoglobin F is replaced by hemoglobin A in what time frame? |
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Definition
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|
Term
| normal hgb levels in newborn infant?(full term) |
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Definition
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|
Term
| Hemoglobin of infant @ 9-12 weeks (2-3 months)up to 2 years? |
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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. |
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|
Term
| how is anemia in the infant defined? how is anemia in the infant at 3 months defined? |
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Definition
| 1)Hgb <13 g/dl 2) Hgb <10 g/dl |
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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) |
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Term
| When does GFR become fully functional in kids? |
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Definition
| 1 year, yet the ability to concentrate urine does not become fully functional until 2-3 years of age. |
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Term
| The primitive moro response and the grasp reflex are a demonstration of? |
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Definition
| central nervous system immaturity at birth |
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|
Term
| When is nerve myelination complete? |
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Definition
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|
Term
| Where does the spinal chord end in a newborn? |
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Definition
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Term
| Never use hypertonic sodium bicarb or dextrose in a newborn-- why? |
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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 |
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Term
| Hepatic system functionality at birth, 1 month, and 1 year |
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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
- 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.
- Bilirubin binds to albumin
- Many of our drugs bind to albumin (this leads to more unbound bilirubin)
- Unbound unconjugated bilirubin can cross physiological membranes.
- Bilirubin in the basal ganglia causes kernicterus, a form of bilirubin driven brain damage.
- Crossing of bilirubin leads to jaundice
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Term
| Results of cold stress on the infant |
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Definition
| increased metabolic rate, decreased supply to tissue (vasoconstriction), decreased uptake (pulmonary vasoconstriction) |
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Term
| how might an infant react to a temp less than 35.5? |
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Definition
| with apnea. Therefore leave intubated if this cold until warmed. |
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Term
| Where should esophageal monitoring be done in the child and why? |
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Definition
| distal portion of esophagus because cool gases can affect results as well as thin abdominal skin of child. |
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