1. Pediatric Emergencies
Airway and Ventilation Management

2. Anatomical Considerations
Airway is much smaller
Tongue is proportionately larger in child in relation to other airway structures
Small amounts of edema or obstruction is more harmful in children (size!)
High position of the larynx makes angle b/n the base of tongue and glottic opening more acute (for tubing..later)

3. General Principals
Anticipate and recognize resp. complications before they arise
Support, or replace, those functions that are compromised or lost
My golden rule, “Airway, airway, airway!”

4. Gen. Principals (cont’)
Conscious Pt’s:
- sit in position of comfort (usually assume position most conducive)
- sit w/ parents
- anxiety increases O2 consumption
Unconscious Pt’s:
-airway becomes obstructed due to relaxation and flexion.
- use noninvasive maneuvers before adjuncts

5. Respiratory Monitoring
Pulse Oximetry is an important technique for monitoring children w/ insufficient respiration. (or even w/out)
Be aware of CO poisoning! Don’t let it fool you
I’m serious!
End Tidal CO2 monitors for pts that are intubated (NON-arrest!)

6. O2 Delivery Systems
Choice of delivery is determined by pt’s status and desired concentration
There are low flow systems (ex…simple mask!)
There are high flow systems (ex…non-rebreather masks!)

7. O2 Masks KIDS HATE MASKS Remember the anxiety thing!
Introduce O2 via blow by or secondary device
Do so in non-threatening way!

8. Oropharyngeal Airways
Used on UNCONS only
Proper sizing…who can tell me?
Too big…may obstruct larynx or traumatize structures of the airway
Too Small… It will push the tongue posteriorly into the pharynx
Use a tongue depressor if available!

9. Suction Devices
A suction force of 80 to 120 mm HG is generally needed…uhhh, ok…
So pick wisely
Flexible plastic suction caths are useful and can be placed even into an ET tube.
Look for bradycardia…monitor pulse when suctioning….why?

10. Management of Resp. Arrest
My three simple rules of quality EMS!
Airway…open and keep it open
Breathing…support it artificially and appropriately
Circulation…access and monitor

11. Arrest Continued
Remember…as soon as respiratory failure or inadequate respirations are noticed, rapid initiation of assisted ventilation is the only appropriate therapy.
More than half (like way more) of peds arrests are due to resp. failure and not cardiac failure.

12. BVM Ventilation Two hands needed One to “compress” bag
Other holds mask and…
Can do a modified jaw thrust at same time!

13. BVM continued To position the head..we call it the “sniffing position”
May have to move head several times to find most beneficial and effective position.
Cricoid pressure anyone?

14. Endotracheal Intubation
What I like to call, “The Meat and Potatoes”

15. ET Intubation Topic Headers
Cuffed vs. Uncuffed
Appropriate Diameter
Appropriate Depth
Blade Type Selection
Techniques for Pediatric Intubation

16. Cuffed vs. Uncuffed Used for peds 8 to 10y.o. or older
Cuff should be inflated until slight leak is audible
Used for peds < 8 years old
Should also have slight audible leak due to anatomy of pedi pt’s.

17. Diameter Equations Use of Broslow Tape or Pedi Wheels
Tube diameter is approx. size of pt’s little finger
Or the following: ET Size = age/4 + 4
Most accurate is the use of a length based tape.

18. Appropriate Depth For pt’s over 2 y.o.: ET Depth = age/2 + 12
But this equation can sometimes result in placement of tube just above the corina.
Try this one: the ET tube size x 3!

19. Blade Types Macintosh Curved Tip is placed in vallecula
Not the best choice for pedi pt’s
Miller
Straight
Lifts the Epiglottis
Better fit for peds due to…
Does anyone remember?

20. Answer!
The high position of the larynx makes the angle b/n the base of the tongue and glottic opening more acute!

21. Techniques/Considerations
Monitor heart rate when intubating
Slightly lubricate the stylet so that it pulls out easier…less room for movement in relation to size of peds.
Pulse oximetry can help monitor hypoxemia during intubation
Secure tube but auscultate lungs prior to doing so to reconfirm placement!

22. Conclusion
Remember…the most important treatment for pedi pt’s is airway management…

23. Conclusion
And remember to not only take care of your pt’s but yourself as well!