4a - Things We Do by W.MURRAY

By W.MURRAY

For kids. FROM keyword phrases studying SCHEME. 4a sequence .42 NEW phrases. HARDCOVER

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Modified from [10 1) First hour • 4 ml/kg for every hour of fluid deprivation prior to surgery Basic hourly fluid • Maintenance 4 ml/kg/h + • Surgical trauma - mild trauma: 2-4 ml/kg/h - moderate trauma: 5-7 mllkg/h - severe trauma: 8-12 mllkg/h Choice of perioperative fluids and transfusion 45 Pyrexia increases the fluid requirements by 12% per degree Celsius and very hot ambient temperature over 31°C may mean the child needs 30% more fluid per degree Celsius above 31 0c. Burn injuries result in an increased fluid requirement of about 4% per percentage of burn on the first day, decreasing to 2% per percent burn area on the second day.

Operative management should be deferred until the child is resuscitated, ensuring perioperative stability. Important examples include the management of CDH as discussed above and children with pyloric stenosis. These children present with hypochloraemic alkalosis as a consequence of electrolyte losses in the vomit. Operation should not be contemplated until the child is appropriately resuscitated and blood biochemistry returns towards normal. In recent years it has been recognised that the performance of nonelective procedures after hours, often by junior surgeons and anaesthetists, is not optimal management [24].

Epiglottis: the adult epiglottis is broad and its axis is parallel to that of the tracheal. E. Meursing the axis of the trachea, it is more difficult to lift the epiglottis with the tip of a laryngoscope blade. 4. Vocal folds: the infant vocal folds have a lower attachment anteriorly than posteriorly (angled), whereas in the adult, the axis of the vocal folds is perpendicular to that of the trachea. e. the tip of the endotracheal tube is caught at the anterior commissure of the vocal folds. 5. Subglottic area: the narrowest portion of the infant larynx is the non-distensible cricoid cartilage; in the adult, it is the rima glottidis.

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