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Principles III, Exam I
Neonate slides 15-20
20
Nursing
Graduate
01/24/2010

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Term
What causes the ductus arteriosus to close?
Definition
Increase in SVR and decrease in PVR
Term
During what time period does the ductus arteriosus functionally close?

Anatomically close?
Definition
Functionally: day 1-8
Anatomically (fibrosis): 1-4 months
Term
What maintains the patency of the ductus arteriosus in utero?
Definition
Prostaglandins (the uterus provides a constant supply)
Term
How can the ductus arteriosus become lifesaving for very young kids?
Definition
A decreased PaO2 can cause the ductus arteriosus to reopen
Term
If all (or even some) fetal shunts remained open - what condition is created?
Definition
Pulmonary HTN
Term
What is the mechanism of pulmonary hypertension and subsequent hypoxia in an infant?
Definition
An increase in PVR creates pulmonary hypertension; this produces a rise in RAP which opens the foramen ovale and ductus arteriosus; this opening leads to deoxygenated blood mixing with oxygenated blood, leading to a drop in PaO2 and cyanosis
Term
What factors precipitate persistant pulmonary hypertension
Definition
hypothermia, hypoxemia, acidosis, pneumonia, meconium aspiration, congenital diaphragmatic hernia
Term
Name 2 treatments for persistent pulmonary hypertension
Definition
nitric oxide (pulmonary vasodilator) and ECMO (for oxygenation)
Term
You are caring for a kid with bilateral choanal atresia. Do you want them to be quiet or cry and why?
Definition
Cry because will switch from nose breathing to mouth breathing and be able to take in larger, more adequate TV
Term
What is choanal atresia? Why is it a problem?
Definition
Conditon where the nasal pharyngeal bone does not regress and can create a nasal obstruction (infants are nose breathers)
Term
You have a kid with choanal atresia on the table - what problem may occur on induction and what can you do to prevent this problem?
Definition
Development of airway obstruction; awake placement of oral airway may work to preserve patency (use lidocaine viscous to localize the tongue to prevent gagging)
Term
Define laryngomalacia and the anatomical structures it involves
Definition
(Soft larynx) = Downward displacement of the aryepiglottic fold during inspiration producing obstruction. Involves: small glottis, long narrow epiglottis, floppy aryepiglottic fold
Term
What are 2 anesthetic implications with laryngomalacia?
Definition
PPV before intubation (supports structures) and down size the ETT
Term
What factors clue you to think about subglottic stenosis?
Definition
prolonged intubation (early gestation, spent time in NICU, intubated/vented, etc); other anomalies (ex: Down's syndrome is associated wtih this)
Term
Where does subglottic stenosis form (anatomically)
Definition
2-3mm below the true cords
Term
I feel resistance when attempting to pass the ETT through the cords. Why could this be occuring? What should I do?
Definition
Resistance could be due to hitting the cricoid cartilage or subglottic stenosis - DO NOT force tube; downsize ETT
Term
What is VATERL?
Definition
A set of anomalies that includes vertebral abnormalities, imperforate anus, tracheoesophageal fistulas, radial aplasia and renal abnormalities, limb abnormalities
Term
What are symptoms of esophageal atresia and tracheoesophageal fistulas?
Definition
excessive secretions, regurgitation of first feeding, occasionally respiratory distress worsened by feedings, recurrent pneumonia
Term
How do you intubate a pediatric with esophageal atresia/tracheoesophageal fistula?
Definition
Intentional right (or left) mainstem - slowly withdraw ETT just until breathsounds are heard.
Term
What are other intubation implications for the pediatric with esophageal atresia/TEF?
Definition
Place precordial in left axilla, goal of cuff location is just distal to fistula, if gastrostomy tube present = CAN do inhalation induction
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