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pediatric airway emergencies: evaluation and management

2. Anatomic and Physiologic Considerations of the Pediatric Airway:. 3. Initial Assessment:. Signs of impending respiratory failure:Reduced level of consciousness or lethargyQuiet, shallow breathingApneaThe above require immediate progression to endoscopy and/or intubation.. 4. History:. Description of OnsetAge at onsetHistory of foreign body aspiration/ingestionAggravating factors: feeding/sleepingHistory of intubationBirth history (syndromes, birth trauma).

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pediatric airway emergencies: evaluation and management

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    1. 1 Pediatric Airway Emergencies: Evaluation and Management Shashidhar S. Reddy, MD, MPH Ronald Deskin, MD January 2002

    2. 2 Anatomic and Physiologic Considerations of the Pediatric Airway:

    3. 3 Initial Assessment: Signs of impending respiratory failure: Reduced level of consciousness or lethargy Quiet, shallow breathing Apnea The above require immediate progression to endoscopy and/or intubation.

    4. 4 History: Description of Onset Age at onset History of foreign body aspiration/ingestion Aggravating factors: feeding/sleeping History of intubation Birth history (syndromes, birth trauma)

    5. 5 Physical Exam: Inspection Ascultation Repositioning

    6. 6 Flexible Laryngoscopy: Proper Equipment Assess nares/choanae Assess adenoid and lingual tonsil Assess TVC mobility Assess laryngeal structures

    7. 7 Radiology: Plain films: Chest and airway AP and lateral Expiratory films High vs. low kilovoltage Fluoroscopy Barium Swallow CT, MRI, Angiography

    8. 8 Flexible Bronchoscopy: Does not require general anasthesia Mainly diagnostic purposes Limited intervention (e.g. suctioning) Can be used for intubation Limited airway control

    9. 9 Direct Laryngoscopy and Rigid Bronchoscopy Indications: Severe or progressive airway obstruction No diagnosis after flexible laryngoscopy and radiology Subglottic pathology suspected Advantages over flexible bronchoscopy: Better control of the airway

    10. 10 Direct Laryngoscopy

    11. 11 Direct Laryngoscopy Insufflation technique:

    12. 12 The Ventilating Bronchoscope

    13. 13 Rigid Bronchoscopy

    14. 14 Rigid Bronchoscopy: Complications: Loss of airway control Injury to subglottic space Damage to teeth or gums Airway bleeding Pneumothorax Failure to recognize pathology

    15. 15 Specific Etiologies of Airway Emergency

    16. 16 Laryngotracheobronchitis

    17. 17 Bacterial Tracheitis (Membranous Tracheitis)

    18. 18 Epiglottitis

    19. 19 Choanal Atresia

    20. 20 Pyriform stenosis

    21. 21 Laryngomalacia

    22. 22 Vocal Cord Paralysis

    23. 23 Subglottic Stenosis

    24. 24 Subglottic Hemangioma

    25. 25 Tracheoesophageal Fistula

    26. 26 Laryngeal Cleft

    27. 27 Vascular Anomaly

    28. 28 Recurrent Respiratory Papillomatosis

    29. 29 Airway Foreign Bodies

    30. 30 Case Study: History Consult from the Neonatal ICU: Newborn infant in increasing respiratory distress since birth. Oxygen saturation is now 100%, but the child has begun to use accessory muscles. Feeding aggravates the distress. Infant has a weak cry, and pediatritians notice noisy breathing. No abnormal birth history.

    31. 31 Case Study: Physical Examination Newborn female infant supine in the bed, sat’ing 100% on room air Moderate use of accessory muscles Moderate biphasic stridor Audible breaths through both nares Repositioning has little effect on stridor

    32. 32 Case Study: Endoscopy

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