Assessment of neonatal & pediatric patient
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Describe anatomy of tounge in infant compared to adult
is proportionally LARGER in proportion to oropharnyx
Describe anatomy of tonsils of infant compared to adut
Much larger than adult in proportion to size which can lead to UAWO
Describe the anatomy of the larnyx of an infant compared to adult
- More anterior and higher.
- Narrowest point at cricoid ring level.
- Funnel shaped. (Adult is cylindrical)
Describe anatomy of epiglottis in infant compared to adult
- proportionally larger.
- omega shaped
- less flexible
- more reactive to stimulation
- Straight blade should be used for intubation
Describe anatomy of trachea in infant compared to adult
- 3-4 mm in diamter at birth (2 mm in adult)
- 5-6 cm in length (12 cm in adult)
Describe anatomy of chest wall in infant compared to adult
- composed mostly of cartilage (UNSTABLE)(no muscle formation yet)
- This makes diaphragm completly responsible for WOB
How does an infant increase Ve?
Solely an increase in RR, NO in Vt
What medication is used during intubation?
what is the conern with "see saw" breathing?
sign of weakness of the diaphragm. must intubate
3 reasons for low pulmonary reserve
- 1. larger heart whioch reduces space for lungs
- 2. larger abdominal contents
- 3. chest have little stabilty & cannot expand properly
What is the Oxygen consumption rate of infant?
6-8 ml/kg (doubled compared to adult)
What factors should be considerd when giving medication to infant?
weight & age
What are 3 rules used to assess gestational age?
- 1. gestational duration based on the last menstrual cycle
- 2. prenatal ultrasound evaluation
- 3. postnatal findings
What are 2 main tools used to assess gestational age?
- 1. Dubowitz gestational age assessment
- 2. Ballard gestational age assessment
Describe Dubowitz assessment
- 11 physical findings
- 10 neurologic findings
- total score = gestational age
What is vernix and when does it appear?
white cheesy substance. supposed to help protect baby skin. appears week 22 should be gone by week 41
appears by weak 26 and disapperar by week 32
What does AGA mean?
- Appropiate for Gestational Age
- 80% of all neonates within range
What does SGA mean?
- Small for Gestational Age
- 10% of neonates fall in range
What does LGA mean?
Large for Gestational Age
What is acrocyanosis and why does it happen? Is t normal?
Yes it is normal. It is cyanosis of the etremities. Caused by immature cappillaries.
What is the Silverman-Anderson Index used for?
- To evaluate the respiratory stauts of the infant only!
- Lower the score the better
Depressed Fontanalles indicates what? Bulging?
- Hypovolemia if depressed.
- Between the skull and brain are the menigies. This contains fluid to protect brain.
Hydroencephalis if bulging. Increased amount of fluid due to lack of drainage.
What Medications are used during NRP?
- Volume expanders
- Lactate of ringers
- O Blood
- Sodium Bicarbonate
- Naloxone(Narcan) (ONLY is mother was high!!)
What are best route of Medication for infants? Through ETT?
ETT= O2, Naloxone, Epinephrine
Epinephrine dosages ? FINSIH !!!!!!!!!!!!!!!!!!!!!!!!!
IV - 1:10,000 solution 0.1 to 0.3
What are the indications of Volume expanders? How is it administered?
- Neonatal- 10 ml/kg over 20 minutes
- Pediatric- 20 ml/kg over 10 minutes
What to monitor post resucitation stabilization
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