Post on 21-Dec-2015
Pediatric Prehospital Pediatric Prehospital Airway ManagementAirway Management
By: Aaron MillsBy: Aaron Mills
11/26/0711/26/07
The Pediatric AirwayThe Pediatric Airway
IntroductionIntroduction Anatomy / PhysiologyAnatomy / Physiology PositioningPositioning AdjunctsAdjuncts IntubationIntubation
IntroductionIntroduction
Almost all pediatric “codes” are of Almost all pediatric “codes” are of respiratory originrespiratory origin
As few as 10% of emergency calls involve As few as 10% of emergency calls involve a peds patient, of which only 1% involve a peds patient, of which only 1% involve
a critically ill or injured child.a critically ill or injured child.
Reasons Why These Reasons Why These Airways Are DifficultAirways Are Difficult
Emotional ResponseEmotional Response Different AnatomyDifferent Anatomy Structures not fully developedStructures not fully developed Large tongueLarge tongue
Pediatric Pediatric Cardiopulmonary ArrestsCardiopulmonary Arrests
10%
10%
80%
Respiratory
Shock
Cardiac
Airway PositioningAirway Positioning
““Sniffing Position”Sniffing Position”
Towel is placed under Towel is placed under the headthe head
Nasopharyngeal AirwayNasopharyngeal Airway
Contraindications:Contraindications: Basilar skull Basilar skull
fracturefracture CSF leakCSF leak
Adjuncts: Oral AirwayAdjuncts: Oral AirwayThe importance of proper The importance of proper
sizesize
Signs of Respiratory Signs of Respiratory DistressDistress
TachypneaTachypnea TachycardiaTachycardia Grunting Grunting StridorStridor Head bobbingHead bobbing FlaringFlaring Inability to lie downInability to lie down AgitationAgitation
RetractionsRetractions Access musclesAccess muscles WheezingWheezing SweatingSweating Prolonged expirationProlonged expiration ApneaApnea CyanosisCyanosis
Intubation: IndicationsIntubation: Indications
Failure to oxygenateFailure to oxygenate Failure to remove COFailure to remove CO22
Neuromuscular weaknessNeuromuscular weakness CNS failureCNS failure Cardiovascular failureCardiovascular failure
Using The Miller BladeUsing The Miller Blade
Better in younger Better in younger children with a floppy children with a floppy epiglottisepiglottis
Straight Laryngoscope Straight Laryngoscope Blade – used to pick up Blade – used to pick up the epiglottisthe epiglottis
ET Tube sizesET Tube sizes
AgeAge kgkg ETTETT Length (lip) Length (lip) NewbornNewborn 3.5 3.5 3.53.5 99 3 mos3 mos 6.06.0 3.53.5 1010 1 yr1 yr 10 10 4.04.0 1111 2 yrs2 yrs 1212 4.54.5 1212
Children > 2 years:Children > 2 years: ETT size: ETT size: Age/4 + 4Age/4 + 4 ETT depth (lip): ETT depth (lip): Age/2 + 12Age/2 + 12
Predicting the Difficult Predicting the Difficult AirwayAirway
Difficulty ventilatingDifficulty ventilating Facial traumaFacial trauma ObesityObesity ObstructionsObstructions Stiff lungs (asthma)Stiff lungs (asthma)
Difficulty intubatingDifficulty intubating External factors External factors
(obesity)(obesity) Evaluate mouth Evaluate mouth
openingopening ObstructionObstruction
Smaller airwaysSmaller airways
Neck mobility Neck mobility (trauma)(trauma)
Back-up PlanBack-up Plan
Can’t ventilate or basics not workingCan’t ventilate or basics not working Consider adjuncts (OPA/NPA/positioning)Consider adjuncts (OPA/NPA/positioning) Intubation?Intubation?
Can’t intubateCan’t intubate Rescue devicesRescue devices
Can’t rescueCan’t rescue Surgical procedureSurgical procedure
Okay to stick with basics if workingOkay to stick with basics if working
OverviewOverview
Anatomy / PhysiologyAnatomy / Physiology PositioningPositioning AdjunctsAdjuncts IntubationIntubation
ReferencesReferences
Hazinski MF, et al (Ed). Hazinski MF, et al (Ed). PALS provider manualPALS provider manual. AHA, 2005. . AHA, 2005. Lee BS, et al. Pediatric airway management. Lee BS, et al. Pediatric airway management. Clin Ped Emerg MedClin Ped Emerg Med. 2001. . 2001.
2(2): 91-106.2(2): 91-106. Lubitz DS. A rapid method of estimating weight and resuscitation drug Lubitz DS. A rapid method of estimating weight and resuscitation drug
doses from length in the pediatric age group. doses from length in the pediatric age group. Ann Emerg MedAnn Emerg Med.. 1998. 1998. 17(6):576-581.17(6):576-581.
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