• Paeds
    • baby
      • Foetus
        • lungs
          • hypoxic pulmonary vasoconstriction
            • only 10% of circulation passes through lungs
        • flow
          • blood passing into umbilical vein is 80% sat (pO2 4.7)
          • 50% passes through ductus venosus
            • bypasses portal vein
          • sats 65% in inferior vena cava
          • 70% passes through foramen ovale
            • ensures heart and brain gets most saturated blood
            • between septum premium and secundum in atria
            • closes immediately and fuses 2/7 after birth
          • 90% of blood bypasses lungs
          • 90% of blood reachiing PA goes through ductus arteriosus
            • between pulmonary artery and DESCENDING aorta
            • provides sats of 55% to lower extremities
            • kept open by PGE2 (levels reduced after birth)
              • which is why NSAIDs should be avoided in pregnancy
            • closes after 2/7 due to high pO2
        • blood
          • Hb 17
          • 55% haematocrit
          • HbF
            • 2 alpha, 2 gamma (abcdeFG)
              • like fetal Ach receptors (have gamma instead of epsilon subunit)
            • gamma units don’t bind to 2,3 DPG like beta units do
            • P50 = 2.5 (rather than 3.5)
            • 50 - 95% HbF at birth, completely replaced by 6 months
          • double Bohr
            • CO2 from fetus diffuses to mother
              • shifts fetal dissociation curve to the left
              • shifts mothers dissociation curve to the right
          • less protein
            • so higher concentrations of protein bound drugs
          • more acidic
            • so get ion trapping —> longer duration of action of basic drugs
        • placenta
          • uterine blood flow
            • up to 750mL/min
              • 85% goes to placenta
          • no autoregulation
          • flow is impaired by alpha stimulation
          • drugs that don’t cross
            • ‘he is going nowhere soon’
            • heparin
            • insulin
            • glycopyrolate
            • NMBs
            • sux
        • Drugs
          • ACE-I's and ARB's absolutely contraindicated
          • Beta-blockers cause IUGR
            • Labetolol is licensed
          • NSAID's may close the DA
      • neonate
        • at birth
          • PVR drops by >80% w. first breath
          • 1st breath generates a pressure of -50 cmH20
          • SVR increases due to intense vasoconstriction of umbilical vessels
            • so L atrial pressure becomes higher than R atrial pressure, and FO closes
        • disease
          • heart
            • non-cyanotic
              • 75%
              • left to right shunt or obstruction
              • structural
                • ASD/VSD/AVSD
                • PDA
              • valvular
                • AS/PS
              • vascular
                • coarctation
            • cyanotic
              • right to left shunt
                • DEOXYGENATED BLOOD PASSES INTO LEFT SIDE
              • 25%
              • Transposition of great vessels
              • tricuspid/pulmonary atresia
              • TOF
                • pulmonary stenosis
                • right ventricular hypertrophy
                  • ‘coeur en sabot’
                • overarching aorta
                • VSD
                • PROVe
    • Infant
      • WETFLAG NOB
        • Weight
          • neonate (up to 28 days)
            • 3.5kg
          • infant (up to a year)
            • (Age in months / 2) + 4
          • 1-10
            • (Age in years + 4) x 2
          • Broselow tape
            • Estimates body weight, tube sizes and drug doses based on height
        • Energy
          • 4J/kg
        • Tube
          • Cuffed
            • (Age /4) + 4
          • Uncuffed
            • (Age /4) + 3.5
          • length at lips
            • (age/2) + 12
          • length at nares
            • (age/2) + 15
          • LMA
            • 1
              • 0-5kg
            • 1.5
              • 5-10kg
            • 2
              • 10-20kg
            • 2.5
              • 20-30kg
            • 3
              • 30-50kg
        • Fluid
          • 10-20mL/kg
          • deficit
            • = weight x %deficit x 10
            • = amount to give over 24hrs
          • maintenance
            • 4mL/kg/hr for 1st 10kg
            • 2mL/kg/hr for 2nd 10kg
            • 1mL/kg/hr for each kilogram afer
        • Lorazepam
          • 0.1mg/kg
        • Adrenaline
          • 0.1mL/kg of 1:10,000
        • Glucose
          • 2mL/kg 10%
        • Needle cric
          • Infant = 18g
          • Child = 14g
        • other drugs
          • paracetamol
            • 15mg/kg (7.5 if <10kg)
          • ibuprofen
            • 10mg/kg
          • diclofenac
            • 1mg/kg
          • codeine
            • 0.5mg/kg)
          • fentanyl
            • 1ug/kg
          • morphine
            • 0.1 - 0.2mg/kg
          • ondansetron
            • 0.1-0.2mg/kg
          • dexamethasone
            • 0.1-0.2mg/kg
        • BP
          • 80 + (age x 2)