There are many instances where children must be given anaesthesia, but due to how fragile they are several ways that it can be done, either through gas flowing through a mask or a needle. As an anaesthetist, you should know how to handle different kids and their reaction to some of these methods and effects of the drugs. BY taking this quiz, you will be able to assess your knowledge. Check them out!
True
False
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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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Desflurane
Succinylcholine
Isoflurane
Vecuronium
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True
False
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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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Sux 5 mg/kg
Ephedrine 750 mcg/kg
Lidocaine 1.5 mg/kg
Atropine 0.02 mg/kg
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5
6
4.5
7
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Myocardial depression
Chest Wall Rigidity
Renal Toxicity
Cytochrome P450 induction
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Cystic Fibrosis
Muscular Dystrophy
Sickle Cell Anemia
Latex Allergy
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Induction
Maintenance
Emergence
Rates are equal during all 3 phases
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Heart Rate
Fluid Balance
O2 Sat
Blood pressure
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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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Asthma Exacerbation
Upper Respiratory Infections
Non-compliance with NPO requirements
Instability due to illness
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True
False
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24 mg IV
6 mg PO
12 mg PO
48 mg PO
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Cardiac
Respiratory
Congenital defects
Circulatory collapse
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4.5
4
3.5
3
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60 ml
50 ml
25 ml
15 ml
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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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Tachypnea, Tachycardia, Tachyphylaxis
Hypotension, Tachycardia, Muscle rigidity
Hypoxia, tachypnea, wheezing, tachycardia
Hypotension, Bradycardia, Low O2 sat
Easier entry across blood brain barrier
Decreased metabolic capabilities
Increased sensitivity of respiratory centers
All the above
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Emergency Surgery
ASA 3-5
Congenital Airway Deformities
Children 1-4 yrs old
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70%, 30%
50%, 50%
40%, 60%
0 %, 100 %
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3
1.5
4
2.5
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Pathologic
Detrimental
Innocent
None of above
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24
22
20
18
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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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5-15%
65-75%
40-60%
80-95%
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0.5
1
1.5
2.5
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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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1.5 mil
3 mac
2.5 mil
2 mac
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Use a couple nurses to make the child lie down and then induce
Stand next to the child, as they sit on the side of the OR table and then apply the mask to induce.
Have the child sit in center of OR table while you sit nearby and wrap your arm around child to induce via mask inhalation.
Use reason, tell the child if they do not lie down you will have to give them a shot instead.
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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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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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Propofol
Ketamine
Inhalational induction with Sevoflurane
Fentanyl & Versed
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Ketamine 8 mg IM
Versed 0.4mg IM
Fentanyl lollipop 40 mcg PO
Atropine 0.08 mg IM
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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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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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Small semi-closed Circuit
Mapleson A
Standard adult semi closed system
Jackson-Rees Circuit
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As soon as I wheel her out of the OR you can take her!
We will watch her in the PACU for 2-3 hours after the procedure and then she may go home.
We will keep her for 48-72 hours just to monitor her for safety.
We will most likely keep her overnight on a pulse oximeter just to watch her.
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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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Intracellular Hyperkalemia
Intracellular Hypernatremia
Intracellular Hypercalcemia
Intracellular Hyperglycemia
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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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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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14 mg
140 mg
35 mg
280 mg
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Review the chart
Introduce yourself to the child’s parents and obtain a thorough history
Introduce yourself to child, and attempt to play a game or comfort them
Get your blow gun ready, and load it with a ketamine dart.
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A 4 month old child
An 11 month old child
A 5 yr old child
A 13 yr old child
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