Review of material for Principles II quiz 2 on pediatric anesthesia.
True
False
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Induction
Maintenance
Emergence
Rates are equal during all 3 phases
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Cystic Fibrosis
Muscular Dystrophy
Sickle Cell Anemia
Latex Allergy
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True
False
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Tachypnea, Tachycardia, Tachyphylaxis
Hypotension, Tachycardia, Muscle rigidity
Hypoxia, tachypnea, wheezing, tachycardia
Hypotension, Bradycardia, Low O2 sat
Use of an overhead radiant heating unit
Use of a water mattress, with circulating warm water
Use cloths dipped in 40o C water and place onto child’s head during procedure
Use a Bair hugger placed on the child’s body
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True
False
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70%, 30%
50%, 50%
40%, 60%
0 %, 100 %
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Desflurane
Succinylcholine
Isoflurane
Vecuronium
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A warthog? Where the heck would you run across those
Ha ha ha!! Spelling is a wonderful thing
Sooo.... he picked up his injured wife and dragged a couple streets over?
All the above
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Myocardial depression
Chest Wall Rigidity
Renal Toxicity
Cytochrome P450 induction
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Give a dose of Tylenol and a respiratory treatement pre-op before continuing with procedure.
It is only an eye surgery, not thoracic so she will be fine.
Talk to the surgeon regarding possibly cancelling the surgery
That depends entirely upon whether Madelyn was a premature baby or has any other coexisting diseases.
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Airway examination and neck stability
Assessing degree of mental retardation
Obtaining history from parents regarding any heart conditions
Assessing for reflux and sings of URI
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Bradycardia and arrhythmias
Laryngeal Edema
Pruritis
Bronchospasm
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Asthma Exacerbation
Upper Respiratory Infections
Non-compliance with NPO requirements
Instability due to illness
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6 hours
8 hours
3 hours
4 hours
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Too much pressure, risk of barotrauma
Too large, circuit will not fit the pedi ETT properly
Too much dead space, and increased work of breathing
Absorber acts to remove almost all gases due to small tidal volume and pt will be undermedicated
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Heart Rate
Fluid Balance
O2 Sat
Blood pressure
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The nerve stimulator should be placed on a spastic extremity as these are best indicators of childs TRUE response to NMB
Placing stimulator on spastic extremity will cause falsely low readings and may lead to underdosing of NMB
Placing stimulator on a spastic extremity may cause falsely high readings and may lead to overdosing of NMB’s
Children with CP do not need nerve stimulators due to their condition.
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Sux 5 mg/kg
Ephedrine 750 mcg/kg
Lidocaine 1.5 mg/kg
Atropine 0.02 mg/kg
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1-2 mcg/kg Fentanyl & O.5 MAC isoflurane
2-4 mcg/kg fentanyl & propfol gtt
0.25-0.5 mcg/kg Dilaudid and 0.3 MAC sevoflurane
1-2 mg/kg dialudid and .6 MAC desflurane
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5-15%
65-75%
40-60%
80-95%
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4.5
4
3.5
3
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Nika who is allergic to Egg yolk
Tyler, whose mom is a nurse
Charlie who has muscular dystrophy
Olivia who has spina bifida
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Approach the parent and attempt to calm him first
Come back later when both are feeling a bit better
Approach the child, and attempt to calm him first.
Give the child some versed.
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Airway has smaller tongue and very stiff epiglottis making visualization difficult
Airway is more superior and has a more acute angulation between plane of tongue and epiglottis
Narrowest portion of airway is the vocal cords, making passage of the ETT much more difficult
None of above
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Exagerrated response and risk for subdural hemorrhage
Infants and kids respond in same manner as adults would
Blunted response due to lower catecholamine stores
More prone to allergic and anaphylactic responses
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Emergency Surgery
ASA 3-5
Congenital Airway Deformities
Children 1-4 yrs old
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Inserting the precordial stethoscope
Applying nerve monitor to assess paralysis
Starting an IV
Turning up the sevo higher
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True
False
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No air leak should be observed
Air leak obersved at 5-10 cm H2O
Air leak observed at 15-20 cm H2O
Air leak observed at 25-30 cm H2O
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60 ml
50 ml
25 ml
15 ml
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Cardiac
Respiratory
Congenital defects
Circulatory collapse
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A precordial stethoscope should be used to evaluate heart tone, rate, and murmurs.
O2 sat probe should be placed on the left hand for the procedure
Twitch monitor should be placed along ulnar nerve at the wrist
The only change to ECG monitoring is the use of pediatric ECG leads and changing alarm limits.
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Not enough information to decide at this time.
No, he is displaying signs of an upper respiratory infection.
Only safe to proceed if pt is given a respiratory treatment and an arterial line inserted to closely monitor hemodynamic stability.
Yeah, he’s fine. We can proceed!
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24 mg IV
6 mg PO
12 mg PO
48 mg PO
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Inhalational induction as patient Is not likely to cooperate with IV placement
IV must be placed prior to procedure for safe induction.
IM induction with ketamine
None of above are appropriate
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Child with cardiac instability who requires surgical intervention
Pt who will be extubated after surgery and requires pain control
A healthy 2 yr old who is no longer at risk for post-op apnea
A child with respiratory insufficiency who may not have sufficient gas exchange for inhalational agents.
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Deliver 100% FiO2
Administer hydrocortisone 5-7mg/kg IV to relieve wheezing
Turn off anesthetic and start propofol gtt to maintain anesthesia
Give B2 agonist such as albuterol 4-8 puffs through ETT
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Nasal intubations are contraindicated
Regional anesthesia is contraindicated
IM injection is preferred since IV sticks may cause bleeding
Transfusions should be done immediately preceding surgery
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Left sternal border 2nd or 3rd intercostals space
Right sterna border 2nd or 3rd intercostals space
Left midclavicular line 5th intercostals space
Depends upon what you are trying to monitor
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Do not extubate, take her to PACU and they can extubate when wheezing goes away
Extubate deep to help prevent laryngospasm
Deliver another albuterol treatment and extubate fully awake
Give Fentanyl 1-2mcg/kg IV to help smooth out extubation
Benadryl 1mg/kg PO
Prednisone 1 mg/kg PO
Zantac 1-2mg/kg PO
All the above
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Conduction
Radiation
Convection
All above are equal contributors to heat loss.
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1.4 per 10,000
2.7 per 100,000
0.5 per 1,000
16 per 1,000,000
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Will give you earliest indication of MH
Will detect hypoxia which is most common cause of pediatric arrest
Allows to asses adequacy of your ventilation
All the above
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5
6
4.5
7
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Pathologic
Detrimental
Innocent
None of above
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Attempts:
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