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Flashcards in Peds PPt-Josh Deck (50)
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1

 

What is normal ICP oin small children

2-4 mmHg

 

2

why is a childs ICP less

 

  • Skull of a newborn doesn't fuse until about the end of 1st year of life
  • Inracranial space more compliant
  • Dura can expand in response to edematous brain tissue fro trauma or mass lesion

 

3

 

b/c the Skull of a newborn doesn't fuse until about the end of 1st year of life and Inracranial space more compliant
    Dura can expand in response to edematous brain tissue fro trauma or mass lesion, what does this mean????

 

May no exhibit s/s of increased ICP until disease is advanced

4

what is the goal of ICP at ANY age?

<20

5

what is the recommended CPP for children younger than 8 (remember adults is about 70)

>40

6

What is the recommended CPP for children older than 8? (remember adult is 70)

> 60

7

 

A CPP less than __ is correlated w/ worse outcomes w/ any ICP in children

<40

8

CBF is tightly coupled to ____ _____

metabolic demand

9

 

There is a larger proportion of ___ to the brain of an infant

CO

10

Autoregulation of CBF is what in newborns?

20-60

11

the neonate is at risk of cerebral _____ and ____ w/sudden hypotension and HTN

Ischemia

IVH

12

What are methods to lower ICP?

  • Same as in adult
  • Elevate head
  • Keep head neutral (prevent kinking of Jugular (JUGGLAR)
  • Hyperventilation
  • Steroids
  • Diuretics

13

Preoperative Eval and Prep:

what should all children get preop? and why? (hint.. a test not labs or drugs)

  • Echo and CV consult
  • B/c CHD may not be appearent immediatel after birth

14


Preoperative Eval and Prep:

shoudl kids get anxioloysis meds?

Fuck yeah!!!!

15

How can Midaz be given

oral

Nasal

IV

16

Intraoperative and Induction:

what is a good induction tech for these munchkins?

 

Inhalation induction w/ sevo and N2O/O2 and a NDMR

or Propofol

RSI for ones w/ risk of aspiration

17

the larynx is funnel shaped and the narrowest point is a the level of the ____

 

Cricoid

18

the larynx is funnel shaped and the narrowest point is a the level of the cricoid, this puts the pt at risk for what?

  • Subglottic obstruction from mucosal swelling postop

19

what can happen the the ETT during the surgery if the surgeon places flexion on the neck

Migrate

20

Since the ETT can migrate what type of intubation is prefered by some providers

nasal intubation

(this just doesn't make any fucking sense, first you want a fast and non-stimulating intubation, well forget that wth this. and 2 the tube seems like it would still migrate considering the nasal passage is located just cephalad the oral cavity.... but thats just me not the test)

21

what happens to the need for NMB in pts on chronic anticonvusants

they may require larger doses, b/c of induced enzymatic metabolism

22

anesthestic preferences are the same as the adult

VAA 1/2 MAC, opioid, etc

23

what fluid to you want to administer NS or LR

NS

24

Do you want to keep pt warm or noral temp or cold

warm (large surface area

25

same as adult

  • A-line
  • Precordial
  • EEG, SSEP. MEP
  • Mannitol
  • etc
  • No differences here not redoing the shit

26

Physiologic Effects of Patient Positioning:

Head elevated (4)

  • Enhanced cerebral venous drainage
  • Decreased Cerebral Blood flow
  • Increased Venous pooling in lower extremities
  • Postural hypotension

27

Physiologic Effects of Patient Positioning

Head down (3)

  • Increased Cerebral venous and intracranial pressure
  • Decreased Functional residual Capacity (lung fxn)
  • Decreased Lung compliance

28

Physiologic Effects of Patient Positioning

Prone ( 3)

  • Venous Congestion of face
    /tongue/ and neck
  • Decreased Lung compliance
  • Increased abdominal pressure can lead to venocaval compression

29

Physiologic Effects of Patient Positioning

Lateral Decubitus (1)

  • Decreased Compliance of down side lung

30

whare does teh Kid go post extubation

  • ICU w/ serial neurological examination