Neo/Peds quiz 3

Smooth muscle contraction occurs when?

Calcium enters the smooth muscle cell causing vasoconstriction.

Smooth muscle relaxation occurs when?

Calcium is prevented from entering or removed from the cell causing vasodilation.

What is maladaptation pulmonary hypertension?

Structurally normal pulmonary vessels that remain constricted.

What lung diseases commonly cause maladaptation?

MAS, RDS, and pneumonia.

What is excessive muscularization?

Remodeling of pulmonary vessels causing increased smooth muscle.

What is hypoplastic vasculature?

Underdeveloped pulmonary blood vessels.

What is the main effect of nitric oxide (NO)?

Pulmonary vasodilation.

What second messenger does nitric oxide increase?

cGMP.

What is the effect of prostaglandins?

Increase cAMP causing pulmonary vasodilation.

What is the effect of endothelin?

Increases calcium and causes vasoconstriction.

What do PDE inhibitors do?

Prevent breakdown of cAMP and cGMP, promoting vasodilation.

What is the first-line treatment for pulmonary hypertension?

Oxygen.

How can mechanical ventilation help pulmonary hypertension?

Corrects acidosis and improves pulmonary vascular tone.

What inhaled pulmonary vasodilator is FDA approved for newborn hypoxic respiratory failure?

Inhaled nitric oxide (iNO).

What is the FDA-approved indication for iNO?

Newborn hypoxic respiratory failure with OI > 25.

What is the Oxygen Index formula?

OI = MAP × (FiO2 ÷ PaO2) × 100.

What Oxygen Index is associated with ECMO consideration?

OI > 40.

How does inhaled nitric oxide improve oxygenation?

Redirects blood flow to ventilated alveoli.

Why are inhaled vasodilators preferred over systemic vasodilators?

They improve V/Q matching and reduce shunt.

What is a major disadvantage of IV vasodilators?

Systemic hypotension and V/Q mismatch.

What congenital heart condition is a contraindication to iNO?

Ductal-dependent congenital heart lesions.

What is the starting dose of inhaled nitric oxide?

20 ppm.

Why are higher doses of iNO generally avoided?

They increase side effects without improving outcomes.

What is the most common cause of iNO treatment failure?

Inadequate lung inflation.

Why must nitric oxide be weaned slowly?

To prevent rebound pulmonary hypertension.

What is rebound pulmonary hypertension?

Worsening pulmonary hypertension after abrupt discontinuation of iNO.

What toxic gas forms when nitric oxide combines with oxygen?

Nitrogen dioxide (NO₂).

What blood abnormality can occur with prolonged iNO doses >40 ppm?

Methemoglobinemia.

What should be monitored while a patient is receiving iNO?

FiO2, NO, NO2, SpO2, methemoglobin levels, blood gases, and tank pressure.

What is the normal methemoglobin level?

0.2-0.6%.

What does ECMO stand for?

Extracorporeal Membrane Oxygenation.

What is ECMO?

Blood is removed, oxygenated outside the body, and returned to the patient.

What is the purpose of ECMO?

Provide temporary cardiac and/or pulmonary support.

What mortality risk is typically associated with ECMO candidates?

Approximately 80%.

What neonatal diagnoses commonly require ECMO?

PPHN, MAS, RDS, sepsis, CDH, and air leaks.

What gestational age is generally required for neonatal ECMO?

Greater than 32 weeks.

What pediatric P/F ratio is associated with 80% mortality?

Less than 75.

What is ECPR?

ECMO initiated during or after cardiopulmonary arrest.

What are the two major ECMO modes?

Venoarterial (VA) and Venovenous (VV).

What does VA ECMO support?

Both heart and lung function.

What does VV ECMO support?

Lung function only.

What vessel returns blood during VA ECMO?

An artery.

What vessel returns blood during VV ECMO?

A vein.

Which ECMO mode is most efficient?

VA ECMO.

Which ECMO mode preserves pulsatile blood flow?

VV ECMO.

What oxygen saturation is commonly seen on VV ECMO until lung recovery?

80-85%.

What are the major ECMO circuit components?

Cannulas, tubing, pump, oxygenator, heat exchanger, sweep gas system, alarms, and pressure monitors.

Why is CO₂ used during ECMO priming?

To displace air from the circuit.

Why is albumin used during priming?

To coat the circuit and reduce clotting.

What determines CO₂ removal across the ECMO membrane?

Sweep gas flow and driving pressure.

What increases CO₂ removal?

Increased sweep gas flow.

What determines oxygen transfer across the ECMO membrane?

FiO₂, blood flow, membrane surface area, and blood path thickness.

What happens if blood moves too quickly through the oxygenator?

Reduced oxygen transfer.

What should be monitored to assess ECMO circuit function?

Temperature, flow, pressure, clots, bubbles, and gas exchange.

What laboratory values help assess organ perfusion during ECMO?

Lactate, creatinine, electrolytes, and SvO₂.

What ACT range is commonly targeted during ECMO?

180-200 seconds.

What anticoagulant is most commonly used during ECMO?

Heparin.

What imaging is commonly used to monitor neurologic status during ECMO?

Cranial ultrasound.

What is the average ECMO duration?

4-6 days.

How is VV ECMO commonly weaned?

Decrease and discontinue sweep gas.

How is VA ECMO commonly weaned?

Increase ventilator support and decrease ECMO blood flow.

What is the most common complication of ECMO?

Neurologic complications.

What are common patient complications of ECMO?

Hemorrhage, IVH, embolism, seizures, arrhythmias, and infection.

What are common mechanical complications of ECMO?

Clots, air emboli, pump failure, oxygenator failure, tubing rupture, and cannula problems.

What is the greatest cause of adverse events during transport?

Communication failures.

What organization accredits medical transport programs?

CAMTS.

What does CAMTS stand for?

Commission on Accreditation of Medical Transport Systems.

What is the purpose of CAMTS accreditation?

Ensure quality and safety standards.

What information should be gathered before transport?

Age, weight, diagnosis, history, vital signs, medications, treatments, and lines.

What is the purpose of a pre-transport assessment?

Determine destination, staffing, equipment, and monitoring needs.

What does "Stay and Play" mean?

Stabilize before transport.

What does "Scoop and Run" mean?

Rapid transport with minimal stabilization.

When is ground transport typically preferred for critical patients?

Less than 30 miles.

When is ground transport preferred for stable patients?

Less than 80 miles.

What transport mode is generally used for distances of 30-150 miles?

Helicopter (rotor wing).

What transport mode is generally used for distances greater than 120 miles?

Fixed wing aircraft.

What is a major advantage of ground transport?

Can operate in poor weather and carry more equipment.

What is a major disadvantage of ground transport?

Traffic delays.

What is a major advantage of helicopter transport?

Rapid response.

What is a major disadvantage of helicopter transport?

Limited space and weather restrictions.

What is a major advantage of fixed wing transport?

Long distance travel with cabin pressurization.

What personnel may be included on pediatric transport teams?

RN, RT, EMT, NP, physician, and safety officer.

Which patients often require an RT during transport?

Ventilated patients and patients needing ≥60% oxygen.

What certifications are commonly required for transport personnel?

BLS, ACLS, PALS, NRP, and STABLE.

What does STABLE stand for?

Sugar, Temperature, Airway, Blood Pressure, Lab Work, Emotional Support.

What communication format is recommended during transport?

SBAR.

What does SBAR stand for?

Situation, Background, Assessment, Recommendation.

What monitoring equipment should accompany transported patients?

ECG, BP, SpO₂, and EtCO₂ monitoring.

What respiratory equipment should accompany transported patients?

Ventilator and manual resuscitator.

What medical gases may be required during transport?

Oxygen, air, nitric oxide, and heliox.

What law explains gas expansion at altitude?

Boyle's Law.

What happens to gas volume as altitude increases?

Gas expands.

What law explains reduced oxygen availability at altitude?

Dalton's Law.

What happens to oxygen partial pressure as altitude increases?

It decreases.

What can happen to an endotracheal tube cuff during air transport?

It expands.

What can happen to a pneumothorax at altitude?

It expands and worsens.