Transcript 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
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
Pediatric Cardiopulmonary
Arrests
10%
10%
Respiratory
Shock
Cardiac
80%
Anatomy
Children are much harder to intubate than adults
Anatomy: Larynx
Narrowest point = cricoid cartilage
Airway Difference
Airway Positioning
“Sniffing Position”
Towel is placed under
the head
Airway positioning for children <2yrs
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
Adjuncts: Oral Airway
The importance of proper
size
Signs of Respiratory
Distress








Tachypnea
Tachycardia
Grunting
Stridor
Head bobbing
Flaring
Inability to lie down
Agitation







Retractions
Access muscles
Wheezing
Sweating
Prolonged expiration
Apnea
Cyanosis
Intubation
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
Newborn
3 mos
1 yr
2 yrs
kg
3.5
6.0
10
12
 Children > 2 years:
 ETT size:
 ETT depth (lip):
ETT
3.5
3.5
4.0
4.5
Length (lip)
9
10
11
12
Age/4 + 4
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)
Easy or Hard?
Easy or Hard?
Easy or Hard?
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
Questions?
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