Practicum III (Peds) Test 2: General Sx


Question Answer NEC: Small margin for error with ____ fluids and blood ***NEC: what diagnostic image would you see that would indicate NEC “Free air” on abdominal radiograph from perforated bowel ***NEC: If left untreated Sepsis and death NEC: T/F – stop TPN false – keep it running! NEC: what about intubation to be leery of? Short – 1cm can mean the difference between out and right mainstemed. Need a decent size tube because will require high pressures – tube without leak below 20cm NEC: what do you need? keep them warm, good IV (20-22 guage), Central line for fluids/CVP, EKG, pulse ox, BP cuff, temp probe, A line?, foley. NEC: Whats one of the big issues massive fluid shifts and 3rd spacing NEC: T/F – one good IV and you're solid true – 22 guage – until after induction – then you need a central line NEC: T/F – 24 guage is still ok for blood – but its going to move very slowly false – need at least a 22 guage NEC: Ideal port for fluids etc central line NEC: induction concerns Don’t give them anything to depress myocardium ex – propofol, thiopental. Ketamine good choice and/or little bit of gas and opioids. Treat as full stomach. NEC: priorities normovolemia, normothermia, adequate ventilation despite high abdominal pressures. VOLUME – CVP should be 8-10 range. Inotropes to keep euvolemic (dopamine drip) NEC: How to maintain hemodynamic stability Euvolemia (with crystalloid/colloid, inotropes), ventilation, normothermia NEC: What should govern your choice of anesthetic? whatever maintains adequate perfusion pressure (inhalation/TIVA) 5 things that get people into trouble with PEDs Anesthetics (depress the myocardium and baroreceptors), Barotrauma (pneumo and hypoxemia), hypovolemia (small volumes and no reserves), pulmonary htn (heart failure), transfusion of blood and FFO: hyperK/HypoCa General PEDs case indications Should be treated as full stomachs, fluid issues especially with intestinal manipulation (use 4-6ml/kg), sepsis causes vasodilation/hyperdynamic state, increased intra-abdominal pressure, blood requirement (have it in the room) ***NEC: summarized necessities be generous with fluids, light on gases, stay intubated (high narcotic technique is good) ***NEC: plan of care (9) full stomach (RSI), Ketamine (if unstable hemodynamically), probably not propofol, CVP (central line), TIVA with high opioid technique, NO NO2, Albumin good replacement, Close attention to blood loss, paralyzed!

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