Pediatrics

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Author:
smithabo
ID:
266470
Filename:
Pediatrics
Updated:
2014-03-14 16:39:37
Tags:
Pediatric anesthesia
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Description:
BC SRNA Pediatric Lectures 1+2
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  1. What gestational ages are considered prematurity and post-maturity?
    • Prematurity = <37 weeks
    • Postmaturity = >42 weeks
  2. What periods of gestation are important for organogenesis and organ function?
    • Organogenesis = first 8 weeks of conception
    • Organ function develops during 2nd trimester
  3. What is the threshold for low birth weight?
    <2500g = LBW
  4. What formula is used to estimate average pediatric weight?
    2 x age (years) + 9 = weight (kg)
  5. What is the average weight of the newborn and infant 1-6 months of age?
    • Newborn = 3.5 kg
    • 1-6 months = 4 kg
  6. What are the risk factors for resorting to transitional (fetal) circulation?
    • prematurity
    • infection
    • acidosis
    • pulmonary disease resulting in hypercarbia or hypoxia
    • aspiration of meconium
    • hypothermia
    • congenital heart disease
  7. What is different about the pediatric heart compared to the adult?
    • Less contractile mass
    • Less compliant ventricles
    • Poor tolerance of increased after load
    • HR dependent CO
    • Reduced endogenous Ca stores
    • Faster HR and lower BP
    • Fixed SV
    • Underdeveloped compensatory mechanisms
    • Hypotension WITHOUT tachycardia
    • Increased metabolic rate
  8. What is the normal O2 consumption of a newborn, child, and adult?
    • newborn = 5-8cc/kg/minĀ 
    • children = 4-6cc/kg/min
    • adult = 3-5cc/kg/min
  9. What is different about the pulmonary system of the pediatric patient?
    • Increased airflow resistance
    • Highly compliant airways
    • Poorly supported surrounding structures
    • Highly compliant chest wall
    • Poorly maintained negative intrathoracic pressure
    • Faster RR
    • Lower FRC in neonates and infants
    • Higher minute ventilation:FRC
    • Poorly developed hypoxic and hypercapnic ventilatory drives
  10. What is different about the pediatric airway?
    • Prominent occiput
    • Disproportionately large tongue
    • Larynx higher in neck (C3-C4) vs. adults (C4-C5)
    • Narrowest part of airway is at cricoid ring
  11. What is important about Type 1 muscle fibers in the intercostal muscles of pediatric patients?
    Number of Type 1 muscle fibers inversely proportional to age - results in faster fatigue R/T tachypnea. By age 2, intercostal muscle development similar to adult.
  12. What is important about the renal anatomy of neonates?
    • Neonates have limited ability to conserve Na and concentrate/dilute urine
    • Increased risk for hyponatremia, hypocalcemia, and hypoglycemia
    • Risk for large evaporative water losses
    • Higher total body water
    • Half life of renal excreted meds prolonged
    • GFR < normal until age 1 yr
    • Tubular function < normal until age 3 yrs

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