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Pediatric Prehospital Airway Management

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

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  1. Pediatric Prehospital Airway Management By: Aaron Mills 11/26/07

  2. The Pediatric Airway • Introduction • Anatomy / Physiology • Positioning • Adjuncts • Intubation

  3. 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.

  4. Reasons Why These Airways Are Difficult • Emotional Response • Different Anatomy • Structures not fully developed • Large tongue

  5. Pediatric Cardiopulmonary Arrests

  6. Anatomy Children are much harder to intubate than adults

  7. Anatomy: Larynx Narrowest point = cricoid cartilage

  8. Airway Difference

  9. Airway Positioning “Sniffing Position” Towel is placed under the head

  10. Airway positioning for children <2yrs

  11. Adjuncts • Nasal airway • Oral airway

  12. Nasopharyngeal Airway • Contraindications: • Basilar skull fracture • CSF leak

  13. Adjuncts: Oral Airway Wrong size: Too Long

  14. Adjuncts: Oral Airway Wrong size: Too Short

  15. Adjuncts: Oral Airway Correct size

  16. Adjuncts: Oral AirwayThe importance of proper size

  17. 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

  18. Intubation

  19. Intubation: Indications • Failure to oxygenate • Failure to remove CO2 • Neuromuscular weakness • CNS failure • Cardiovascular failure

  20. Laryngoscope Blades Macintosh Miller

  21. Using The Miller Blade Better in younger children with a floppy epiglottis Straight Laryngoscope Blade – used to pick up the epiglottis

  22. 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

  23. 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)

  24. Easy or Hard?

  25. Easy or Hard?

  26. Easy or Hard?

  27. 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

  28. Overview • Anatomy / Physiology • Positioning • Adjuncts • Intubation

  29. Questions?

  30. 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

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