Pediatric Prehospital Airway Management

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Pediatric Prehospital Airway Management

• By Aaron Mills
• 11/26/07

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The Pediatric Airway

• Introduction
• Anatomy / Physiology
• Positioning
• Adjuncts
• Intubation

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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.

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Reasons Why These Airways Are Difficult

• Emotional Response
• Different Anatomy
• Structures not fully developed
• Large tongue

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Pediatric Cardiopulmonary Arrests
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Anatomy
Children are much harder to intubate than adults
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Anatomy Larynx
Narrowest point cricoid cartilage
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Airway Difference
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Airway Positioning

• Sniffing Position
• Towel is placed under the head

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(No Transcript)
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• Airway positioning for children lt2yrs

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Adjuncts

• Nasal airway
• Oral airway

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Nasopharyngeal Airway

• Contraindications
• Basilar skull fracture
• CSF leak

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Adjuncts Oral Airway
Wrong size Too Long
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Adjuncts Oral Airway
Wrong size Too Short
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Adjuncts Oral Airway
Correct size
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Adjuncts Oral AirwayThe importance of proper
size
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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

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Intubation
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Intubation Indications

• Failure to oxygenate
• Failure to remove CO2
• Neuromuscular weakness
• CNS failure
• Cardiovascular failure

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Laryngoscope Blades
Macintosh
Miller
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Using The Miller Blade

• Better in younger children with a floppy
  epiglottis

• Straight Laryngoscope Blade used to pick up the
  epiglottis

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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 gt 2 years
• ETT size Age/4 4
• ETT depth (lip) Age/2 12

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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)

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Easy or Hard?
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Easy or Hard?
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Easy or Hard?
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Back-up Plan

• Cant ventilate or basics not working
• Consider adjuncts (OPA/NPA/positioning)
• Intubation?
• Cant intubate
• Rescue devices
• Cant rescue
• Surgical procedure
• Okay to stick with basics if working

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Overview

• Anatomy / Physiology
• Positioning
• Adjuncts
• Intubation

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• Questions?

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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