Pediatric airway management   shapiro
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  • 1
  • Adult – VF or Pulseless VT
  • If asystolic, mortality > 90%
  • 4
  • 7
  • 5
  • 9
  • 10

Transcript

  • 1. Pediatric Airway Management Dr. Shapiro I., PICU Dec 2003
  • 2. Adult Chain of Survival Early Defibrillation CPR ALS EMS
  • 3. Pediatric Chain of Survival Prevention ALS CPR EMS
  • 4. Out-of-Hospital Cardiac Arrest
    • SIDS
    • Trauma
    • Submersion
    • Poisoning
    • Choking
    • Severe Asthma
    • Pneumonia
  • 5. In-Hospital Cardiac Arrest
    • Sepsis
    • Respiratory Failure
    • Drug Toxicity
    • Metabolic Disorder
    • Arrhythmias
  • 6. Pediatric Cardiorespiratory Arrests 10% 10% 80%
  • 7. Pediatric Cardiorespiratory Arrests Hypoxia and Hypercarbia Bradycardia RESPIRATORY ARREST CARDIOPULMONARY ARREST
  • 8. Schindler M, et al. Outcome of out-of-hospital cardiac or respiratory arrest in children. N Engl J Med 1996;335 : 1473-1479 Arrive in ER in cardiac arrest (N = 80) Admit PICU (N=43) 54 % Died in ER (N=37) 46% Mod Deficit (N=3) PVS at 12 mos (N=2) Dead at 12 mos (N=1) Died in ICU (N=37) 46% Outcome of cardiac arrest in children
  • 9. Survival from Respiratory Arrest Respiratory Arrest Alone – more than 50% neurologically intact survival rate
  • 10. Pediatric Chain of Survival Prevention ALS CPR EMS
  • 11. To Simplify the Message… Early Defibrillation 8 years Age With exceptions… (submersion, trauma, drug overdose) With exceptions… (sudden collapse, cardiac history)
  • 12. PREVENTION 1992 SIDS SIDS More Than 50%... "BACK TO SLEEP"
  • 13. Respiratory Distress Respiratory Failure and Respiratory Arrest BLS
  • 14. Evaluation of Respiratory Performance
    • Respiratory Rate and Regularity
    • Level of Consciousness
    • Color of the Skin and Mucous Membranes
    • Respiratory Mechanics
  • 15. Respiratory Mechanics
    • Head Bobbing
    • Nasal Flaring
    • Retractions
    • Grunting
    • Stridor
    • Wheezing or Prolonged Exhalation
  • 16. Upper Airway Obstruction turbulence
  • 17. Lower Airway Obstruction turbulence & wheezing
  • 18. Anatomy Children are very different than adults !!!
  • 19. Anatomy : Airway Nose Tongue Epiglottis Vocal Cords Larynx
  • 20. Anatomy: Larynx
    • Narrowest point = cricoid cartilage
    INFANT ADULT
  • 21. Physiology
    • Tongue - Posterior Displacement
    • Tongue – Difficult to Control
    • Epiglottis – Difficult to Control
    • Vocal Cords – Difficult Intubation
    • Tube size relative to Cricoid Diameter
    • Small Airway Edema causes High Resistance
  • 22. Effect Of Edema Poiseuille’s law
  • 23. Basic Life Support A+B
  • 24. Two Steps Before…
    • 1. Ensure the Safety of Rescuer and Victim
    • ( the scene, gloves, barrier devices)
    • “ Partial” CPR: Is Something Better than Nothing?
    2. Stimulate and Check Responsiveness
  • 25. Airway Head Tilt-Chin Lift Jaw Thrust + Tongue-Jaw Lift Maneuver (FBAO)
  • 26. Breathing
    • Check Breathing
    Look Listen Feel Recovery Position Rescue Breathing
  • 27. Ventilation with Oxygen
    • Mouth-to-Mouth ventilation provides only 17% O 2
    • Indicated to all seriously ill or injured patients even if pCO 2 is high
    • If Possible – humidify Oxygen
    • Use of reduced FiO 2 is uncommon
  • 28. Devices to Monitor Respiratory Function
    • Pulse Oxymetry
    • End-Tidal CO 2
    • Arterial Blood Gas Analysis
  • 29. Oxygen Delivery Systems
    • Oxygen Mask
    • Face Tent
    • Oxygen Hood
    • Oxygen Tent
    • Nasal Canula
  • 30. Oropharyngeal Airway SIZE PROPER POSITION
  • 31. Nasopharyngeal Airway
  • 32. Nasopharyngeal Airway
  • 33. Bag-Mask Ventilation Proper area for mask application
  • 34. Bag-Mask Ventilation Sellick Maneuver
  • 35. Laryngeal Mask Contraindicated if gag-reflex is intact Higher success rate Does NOT protect from aspiration Difficult to maintain during transport
  • 36. Intubation
  • 37. Intubation: Indications
    • Failure to oxygenate
    • Failure to remove CO 2
    • Increased WOB
    • Neuromuscular weakness
    • CNS failure
    • Cardiovascular failure
  • 38. Tracheal Tube Children > 2 years: ETT size: (Age+16)/4 ETT depth (lip): ETTsize x 3 Age kg ETT Length 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
  • 39. Laryngoscope Blades Better in younger children with a floppy epiglottis Straight
  • 40. Laryngoscope Blades Better in older children who have a stiff epiglottis Curved
  • 41. Intubation Technique
  • 42. Confirmation of ETT Placement
    • NO single technique is 100% reliable
    • Clinical Confirmation
    • Chest X-ray
    • CO2 Detection
    • Esophageal Detector Devices
  • 43. Clinical Confirmation
    • Chest rise
    • Water vapor seen inside tube
    • Breath sounds - lung
    • Breath sounds – epigastrium
    • O 2 Saturation
  • 44. Acute Deterioration after Intubation
    • D.O.P.E : D isplacement
            • O bstruction
            • P neumothorax
            • E quipment failure
  • 45. Inadequate Improvement after Intubation
    • Inadequate Tidal Volume
    • Excessive Leak Around The Tube
    • Air Trapping and Impaired Cardiac Output
    • Leak or Disconnection in Ventilator System
    • Inadequate PEEP
    • Inadequate O 2 Flow from Gas Source
  • 46. Percutaneous Cricothyrotomy
    • Complete UA Obstruction:
    • FBAO
    • Severe Orofacial Injuries
    • Upper Airway Infections
  • 47.
    • See You at Next Week’s Workshop
    • Happy Khanukka