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Pediatric Prehospital Airway Management. By: Aaron Mills 11/26/07. The Pediatric Airway. Introduction Anatomy / Physiology Positioning Adjuncts Intubation. Introduction. Almost all pediatric “codes” are of respiratory origin
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Pediatric Prehospital Airway Management By: Aaron Mills 11/26/07
The Pediatric Airway • Introduction • Anatomy / Physiology • Positioning • Adjuncts • Intubation
Introduction Almost all pediatric “codes” are of respiratory origin As few as 10% of emergency calls involve a peds patient, of which only 1% involve a critically ill or injured child.
Reasons Why These Airways Are Difficult • Emotional Response • Different Anatomy • Structures not fully developed • Large tongue
Anatomy Children are much harder to intubate than adults
Anatomy: Larynx Narrowest point = cricoid cartilage
Airway Positioning “Sniffing Position” Towel is placed under the head
Adjuncts • Nasal airway • Oral airway
Nasopharyngeal Airway • Contraindications: • Basilar skull fracture • CSF leak
Adjuncts: Oral Airway Wrong size: Too Long
Adjuncts: Oral Airway Wrong size: Too Short
Adjuncts: Oral Airway Correct size
Tachypnea Tachycardia Grunting Stridor Head bobbing Flaring Inability to lie down Agitation Retractions Access muscles Wheezing Sweating Prolonged expiration Apnea Cyanosis Signs of Respiratory Distress
Intubation: Indications • Failure to oxygenate • Failure to remove CO2 • Neuromuscular weakness • CNS failure • Cardiovascular failure
Laryngoscope Blades Macintosh Miller
Using The Miller Blade Better in younger children with a floppy epiglottis Straight Laryngoscope Blade – used to pick up the epiglottis
ET Tube sizes • Age kg ETT Length (lip) • Newborn 3.5 3.5 9 • 3 mos 6.0 3.5 10 • 1 yr 10 4.0 11 • 2 yrs 12 4.5 12 • Children > 2 years: • ETT size: Age/4 + 4 • ETT depth (lip): Age/2 + 12
Predicting the Difficult Airway • Difficulty ventilating • Facial trauma • Obesity • Obstructions • Stiff lungs (asthma) • Difficulty intubating • External factors (obesity) • Evaluate mouth opening • Obstruction • Smaller airways • Neck mobility (trauma)
Back-up Plan • Can’t ventilate or basics not working • Consider adjuncts (OPA/NPA/positioning) • Intubation? • Can’t intubate • Rescue devices • Can’t rescue • Surgical procedure • Okay to stick with basics if working
Overview • Anatomy / Physiology • Positioning • Adjuncts • Intubation
References • Hazinski MF, et al (Ed). PALS provider manual. AHA, 2005. • Lee BS, et al. Pediatric airway management. Clin Ped Emerg Med. 2001. 2(2): 91-106. • Lubitz DS. A rapid method of estimating weight and resuscitation drug doses from length in the pediatric age group. Ann Emerg Med.1998. 17(6):576-581. • www.emsresponder.com