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Neonates
OB, Peds, etc.
| Question | Answer |
|---|---|
| the five most frequent major surgical procedures performed in the first week of life? | CDH, omphalocele and gastroschisis, tracheoesophageal fistula (TEF), intestinal obstruction, and meningomyelocele. |
| Which of the five most freq. major surgical procedures are obvious at birth? | CDH, omphalocele and gastroschisis, and meningomyelocele |
| this condition is seen in weeks 5-10 of fetal life abdominal contents extruded into extraembronic coelom and does not return at week 10 | oomphalocele |
| what is oomphalocele covered with? | amnion |
| where is the umbilical cord located in a oomphalocele | apex of the sac |
| T or F oomphalocele is associated with a high risk of associated congential anomalies? | True |
| CHD is associated with what % of oomphalocele | 25% |
| what is Beckwith-Wiedemann syndrome consist of? | omphalocele, mental retardation, hypoglycemia, large tongue, congenital heart disease |
| when does the gut returnto the abdominal cavity | 10th week |
| what does the amnion do? | protects the abdominal contents from infection and the loss of extracellular fluid |
| T or F gastroschisis develops later in fetal life? | True |
| T or F there is a high incidence of associated congenital anomalies with gastroschisis but not with omphalocele | False; vice versa |
| this develops after abdominal content returned | gastrochisis |
| how does gastrochisis develop? | interruption of the omphalomesenteric artery, which results in ischemia and atrophy of the various layers of the abdominal wall at the base of the umbilical cord. the gut herniates through this tissue defect. |
| where is the umbilical cord located in gastrochisis | one side of the intestinal contents |
| you have a high risk for what in gastrochisis | infection; no protective covering |
| how can you dx oomphalocele and gastrochisis | alpha-fetoprotein (ATF), ultrasound |
| what causes high levels of ATF? | inadequate closure of the abdominal wall and neural tube. |
| high levels of ATF means? | concerns of abdominal wall defect or nerual tube defect in the fetus |
| which is more urgent gastrochisis or omphalocele | gastrochisis |
| preop: respiratroy failure is associated with____ | omphalocele |
| preop: gastroschisis is associated with | infection |
| during gastrochisis and omphalocele surgery it is important to have ___ ____ ____ when gut is returning to the abd. | lower extrem. pulse ox; to make sure on occlusion of the fem. art. is not being occluded. |
| preop: it is important to ___ gastrochisis to prevent infection | bagging |
| preop care | search for assoc. anomalies, ABC's, fluids and electrolytes, CVP, A/L, ventilation, muscle relax, no nitrous, |
| ways to protect the bowel, minimize fluid and temp. loss with gastroschisis | bagging |
| a difficult airway can be anticipated in pts with | beckwith-Wiedemann syndrome |
| fluid vol administration often is balance with | salt solution |
| nitrous oxide should not be used b/c? | it increases the gas in the intestines |
| if primary closure is impossible what is incorporated? | silo |
| muscle relaxant are required during closure of the abd? | it is necessary to allow closure of the abd. |
| post-op: the increased abdominal pressure can have affect the kidneys by? | reducing the circulation to the kidney resulting in release of renin. |
| what can the HTN be associated with during increased abd. pressure during closure | renin release from decrease circulation to the kidneys |
| postop concerns after closure? | lower extrem. edema and HTN |
| diaphragm forms b/n | 5 to 10 weeks |
| the gut is herniated or extruded to the extraembryonic coelom during | ninth or tenth week |
| how does the congenital diaphragmatic hernia develop | in the 9th or 10th week the developing gut returns to the peritoneal cavity, if there is a delay or incomplete closure of the diaphragm, or it the gut returns early, a diaphragmatic hernia develops |
| what is not known for sure about the diaphragm | why defects or holes occur in the diahragm |
| CDH occurs in how many live births and still births? | 1 in 4000 1 in 2000 still |
| what is the mortality of CDH | 40-50% |
| 90% of CDH is ___-side | left |
| what portion of the diaphragm closes later | left (foramen of bochdalek) |
| what is the right-sided foramen called? | foramen of morgagni |
| what can develop during CDH that puts the neonate at more risk | pulm. hypoplasia, hyper-reactive pulm. vasulature, LV hypoplasia |
| how do you dx CDH | ultrasound |
| the occurence of symptoms of the clinical presentaion of CDH depends on | the degree of herniation and interference with pulm. fx. |
| what are the initial clinial findings with CDH | scaphoid abd. (sunken in abd) decreased breathe sounds(L), and resp. failure |
| excessive airway pressures with CDH can cause | a high risk for pneumo., barotrauma |
| appears week 2-4 of later, nonbilous vomitting | pyloric stenosis |
| untreated pyloric stenosis leads to | hypokalemic, hyponatremic, hypochloremic, metabolic alkalosis, 33-36% with hyperkalemia later:respiatory acidosis |
| how is pyloric stenosis dx | H&P, palpable "olive" or mass, u/s, xray |
| what is a medical emergency | pyloric stenosis |
| why is atrophine given prior to rapid sequence of an neonate | to produce some kind of sympathetic response since theirs isn't developed |
| conventional ventilation with permissive hypercapnia60-65 favored with | CDH |
| preop diaphragmatic hernia avoid | hypothermia, acidosis which can precipitate pulm. HTN, nitrous, muscle relaxants, diff. abd. closure |
| patho of CDH | cardiac development may be impaired, LV hypoplasia with attenuated muscle mass and cavity size |
| newborn | first 24 hrs |
| crista dividends | a structure that divides right atrium |
| how does the foramen ovale remain open | RAP>LAP |
| the Pulm. vascular bed has a high vascular resistance b/c | the alveoli are relatively closed and filled with fluid and bld vessels compressed |
| decreased PAO2 and decreased pH | increase PVR |
| the ductus artenosus represents a low-resist. syst. b/c it is | dilated 2ndary to a low PAO2 |
| the transition of the alveoli from fluid-filled to air-filled results in | low compression of the pulm. alveolar capillaries with a decreased in PVR over first several hours |
| how long does it take PVR to decrease | 2-3 days |
| decrease PVR is accompanied by | constriction of the ductus arteriosus 2ndary to oxygentation=increase in pulm. bld flow and an increase in L atrial pressure so foramen ovale functionally closes |
| when are DA and FO permanently closed | lst several mnths |
| with ventilation the first 5-10min what ocurs? | normal ventilatory vol. develop and normal TV |
| initial negative intrathoracic pressure generated | 40-60 cm H2O |
| when is FRC near normal and bld gases stablized | by 10 to 20 min. of life |
| placenta oxygenates> | inferior vena cava, R atrium, foramen ovale,L atrium, LV, ascending aorta |
| bld returns upper body> | R side by SVC directed by crista dividends, RV, PA, 90% ductus arteriosus, descending aorta, and 10% PA, pulm. vascualr bed for growth of lungs and surfactant production |
| what cause the DA to open/close | decrease pO2, decrease pH, prostaglandins(placenta) close:increasepO2, pH, no prostaglandings |
| 95% of babies have closed DA in __, and permanent in ___ | 48-72 hrs, 2-3wks |
| PPH | presistent pulm HTN |
| elevated PVR to the pt what venous bld is diverted to some degree through fetal channels | PPH |
| what can cause DA and FO to remain open | PPH |
| systemic aterial hypoxemia | PPH |
| primary causes: unknown 2ndary causes: PPH | meconium aspirat., sepsis, PNA, Resp. distress, CDH |
| what can be a sign of interuterine fetal hypoxia | meconium aspiration |
| what are the classification of PPH | 1. PPHN with pulm. parenchymal disease, 2.PPHN with radioraphical normal lung, 3. PPHN with lung hypoplasia |
| what is the goal of PPH txment | PAO2 50-70 cmH2O PACO2 40-60 cmH2O |
| this is inhaled, selective pulm. vasodilation for txment for PPH | nitric oxide |
| ECMO | extracorporeal membrane oxygentation |
| risk of ECMO | bleeding, clot, stroke, infect, eq. fail, labor time, expensive |
| functional, physiologially closed, permanent anatomic closure: | 12hrs, 2nd day, first 2 months |
| s/s of PDA | poor feeding, poor wt.gain, tachycardia, dyspnea, CHF |
| PDA is what kind of shunt | L to R, inceases pulm. bld flow=CHF |
| risk factor for PDA | endocarditis |
| PDA txment | indomethacin, ligation, |
| what is ductal depend. congential heart disease | needs PDA to survive 1)lesion with restricted pulm. bld flow(pulm. atresia or stenosis, tricuspid atresia) 2)mitral atresia, aortic atresia, preductal coarctation, interrupted aortic arch |
| txment for ductal depend. CHD | needs prostag. to keep PDA open |
| PFO in what % of adults | 20-30 |
| umbilical arterty and umbilical ligaments turn into | umbilicalligaments and superior vesicular artery to bladder |
| what are the newborn anatomial airway diffences | lg tougue, high glottis, narrow cricoid ring, slanting vocal cords, lg occiput |
| what type of breathers are neonatal | obligate nose |
| most common cause of airway obstur | tongue |
| narrowest portion for neonates | cricoid ring |
| what age does the narrowest portion change | <10 |
| neonatal pulm. syst. differs by | high O2 consumption, high closing volumes, high ratio of MV to FRC, pliable ribs |
| O2 consumption adults 3ml/kg/min for infant | 7-9ml/kg/min |
| lung volumes at with alveoli close, resulting in the shunting of bld by a closed alveolus | high closing volumes |
| high closing volumes of the neonate's lung are w/in the range of | normal tidal volumes |
| neonate have increased O2 consumption, what helps | increased alveolar ventilation |
| neonates have a high ration minute volume to | FRC |
| neonatal ratio of MV to FRC | 5:1 |
| 5:1 ratio results with anesthesia | rapid induction and emergence from inhalational anesthesia |
| neonate has a higher % of body wt as | vessel rich groups |
| FRC in infants? | 27-30 ml/kg |
| neonates FRC | 23ml/kg |
| type 1 muscle | slow twitch, high oxidation for sustained muscle activity |
| diaphargm has type 1 till | 8 mnths |
| fast twitch muscle | decreased oxidative, immed. but short activity |
| intercostal muscle achieve maturity | by 2 mnths |
| neonates has more CO than adults compared to body wt. b/c | increased O2 consumption |
| poor contractility results in relatively | fixed SV |
| what makes the heart stiffer and less contractile than adults | rich mitchondria and ER |
| neonates has decrease SVR 2ndary to | pristine vessels |
| MAP | 35-40 |
| babies have a fully developed parasympath. prone to | bradycardia |
| myocardial stimulation produces | limited increase in CO or contractility 2dary to undeveloped sympathetics |
| what is the major cause of bradycardia | hypoxia |
| in the sniffing position the head is ___ and the neck is ___ | flexed;extended |
| place roll under shoulders for ages | <2 years of age |
| place roll under neck what ages | 6-11 |
| infant airway differs in five ways | larynx ↑ in the neck: preemieC3, term C3-4, adult C4-5 2)lg tongue 3)epiglot. short, stubby, angled away from tracheal axis 4)infant v/c have a ↓ attachment ant. than post. vs adults 5)narrowest part of the infant n young ped airway cricoid cartilage |
| Sodde's law of anesthesia | the laryngoscope light stays on until the blade is down the pt's throat |
| how long is the average NB trachea from vocal cords to carina | neonate 5cm adult 8-13cm |
| beyond 2 years formula for internal distance | age + 16/4 |
| distance of insertion | age + 12/2 |
| cuff tracheal tube | low press, high vol cuff generaly indicated for children 8-10yrs or older |
| ETT tube size formulas | premature 1-2-3-4 kg 7-8-9-10cm |
| down's syndrome | macroglosdsia, cervical spine stability, congenital subglottic stenosis, atlantoaxial subluxation20%, congenital heart disease(AV canal defects |
| micrognathia | may be the most common cause of a difficult airway in infancy |
| mandible develops from the first branchial arch | micrognathia |
| micrognathia abnormalities | hemifacial microsomia, bilateral 1st arch synd., treacher collins synd., pierre robin synd. |
| preauricular skin tags or abnormally developed external ears, may be used as a | marker for a potentially difficult intubation with micrognathia |
| natural hx of most of these airway problems is they | improve with age and growth |
| T or F the tongue is easily displace during direct laryngoscopy | T |
| management tips of micrognathia | laryngoscope is inserted on the extreme R side of the oral cavity (retromolar) |
| bilateral 1st arch syndrome | a very rare disease charact. by complete absence of the mandible and other structures derived from the 1st branchial arch. |
| underdeveloped cheek and jaw, down slanting eyes, ear deformitites, | treacher collins syndrome |
| goldenhar's synd. | rare congenital do of hemicariofacial and vertebral defects related to the abnormal development of the 1st and 2nd branchial arches |
| these infants not only have a difficult managed airway, congenital heart disease, pulm. and renal defects | goldenhar's syndrome |
| goldenhar's syndrome:difficult tracheal intub. may be due to a combination of | retrognathia, micrognathia, mandibular hypoplasia, palatal defects and vertebral anomalies |
| myocardiacl stimulation of a neonate produces a increases in CO and contractility | false;neonates lack sympath. |
| what contributes to formation of amniotic fluid | fetal urine |
| whar are the 4 major reasons for low RBF and GFR | low syst. arterial press., increased reanl vascualur resistance, decreased permeability of the glomerular cap., small size and # of glomeruli |
| meonate concentrates and produces unrine within | 3-4 days |
| in 1 mnth kidneys mature to | 70% |
| why considered obligate Na losers | tubular con't to reabsorb Na |
| neonate unrine Na | 20-25meq/L |
| 80% of fetal Hgb is | HgbF increased affinity for O2; |
| newborn Hgb levels falls for the first | 6-8wks NB fluid should contain Na |
| 4-2-1 Rule | (0-10kg)=4ml/kg/hr (11-20kg)=2ml/kg/hr (>20kg)=add 1ml/kg/hr |
| maintenance Na for infants is | 3 to 5 meq/kg/day |
| how to calculate replace NPO | hourly maintenance X hours NPO (1/2 1st hr) (1/4 2nd hr) (1/4 3rd hr) |
| problems with temp regulation | lg SA, small mass to generate heart, poor insulation, inability to shiver |
| what is the major source of heat production in cold stressed neonates | catecholamine stimulation, nonshibering, thermogenesis by brown fat |
| brown fat forms in | 26-30 wks gestation |
| brown fat produces heat by | fatty aci metabolism |
| name 5 ways to treat heat loss | radiant heat lamps, warming blankets, hats-wrapping limbs, warm-humidified gas, warmed IV fluids |
| increased bulirubin load comes from | poor hepatic conjugation |
| increased bilirubin comes from | 75% from rbc destruction/UDP-glucuronyl/transferance reaches normal at age 3 |
| what makes bilirubin water soluble for excretion | UDP-glucuronyl transferance |
| what is the COPD for neonates | bronchopulm. dysplasia |
| neonate unrine Na | 20-25meq/L |
| 80% of fetal Hgb is | HgbF increased affinity for O2; |
| newborn Hgb levels falls for the first | 6-8wks NB fluid should contain Na |
| 4-2-1 Rule | (0-10kg)=4ml/kg/hr (11-20kg)=2ml/kg/hr (>20kg)=add 1ml/kg/hr |
| maintenance Na for infants is | 3 to 5 meq/kg/day |
| how to calculate replace NPO | hourly maintenance X hours NPO (1/2 1st hr) (1/4 2nd hr) (1/4 3rd hr) |
| problems with temp regulation | lg SA, small mass to generate heart, poor insulation, inability to shiver |
| what is the major source of heat production in cold stressed neonates | catecholamine stimulation, nonshibering, thermogenesis by brown fat |
| brown fat forms in | 26-30 wks gestation |
| brown fat produces heat by | fatty aci metabolism |
| name 5 ways to treat heat loss | radiant heat lamps, warming blankets, hats-wrapping limbs, warm-humidified gas, warmed IV fluids |
| increased bulirubin load comes from | poor hepatic conjugation |
| increased bilirubin comes from | 75% from rbc destruction/UDP-glucuronyl/transferance reaches normal at age 3 |
| what makes bilirubin water soluble for excretion | UDP-glucuronyl transferance |
| what is the COPD for neonates | bronchopulm. dysplasia |
| txment for BPD | O2, bronchodilators, diuretics,ventilation |
| txment for NEC | IV hydration, ax, D/C feeds, surgical exploration, resection of damaged bowel |
| intraventricular hemorrhage occurs more in 500-750gm or 1000-1500gm infants | 500-750gm (60-70%) (10-20%) |
| what type of infant is at risk for postop apnea and bradycardia | ex-preemies <60wks PCA full term at risk 44-46 wks tx with anticholinergic |
Created by:
melbacs
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