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Pediatric Airway Management Dave French, MD, NREMT-P Attending ED Physician, Albany Medical Center Medical Director, Albany & Schenectady Fire Departments
Goals ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Decision-making ,[object Object],[object Object],[object Object],[object Object]
Reasons to Manage Airway ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
BLS vs. ALS ,[object Object],[object Object],[object Object],[object Object],[object Object]
Who Should Be Intubated? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Who Should Be Intubated? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Should we be intubating ANY pediatric patients?!?! Jury is still out, but some states already forbid it.
Predicting the Difficult Airway ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Easy or Hard?
Easy or Hard?
Easy or Hard?
The Debate on Prehospital Pediatric Intubation Continues…
Back-up Plan ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
It’s Not Okay to Continue with Failed Techniques
Long-Term Issues ,[object Object],[object Object],[object Object],[object Object]
Long-Term Issues ,[object Object],[object Object],[object Object],[object Object],[object Object]
Basics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intubation - Preparation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Airway Equipment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Airway Equipment ,[object Object],[object Object],[object Object],[object Object]
Tube Size ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tube Placement ,[object Object],[object Object],[object Object]
Intubation - Positioning ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Positioning- Medical vs. Trauma Adapted from  Walls et al.  Manual of  Emergency  Airway Management.  2 nd  Ed. 2004.
Positioning Adapted from  Walls et al.  Manual of  Emergency  Airway Management.  2 nd  Ed. 2004.
Intubation - Approach ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Airway Differences Nose Tongue Trachea Cricoid Airway
Airway Differences Adapted from  Walls et al.  Manual of  Emergency  Airway Management.  2 nd  Ed. 2004.
Airway Shape Adapted from  Walls et al.  Manual of  Emergency  Airway Management.  2 nd  Ed. 2004.
Intubation - Approach ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Other Considerations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intubation - Techniques ,[object Object],[object Object],[object Object],[object Object],[object Object]
Blade Placement Adapted from  Walls et al.  Manual of  Emergency  Airway Management.  2 nd  Ed. 2004.
Intubation - Trouble-shooting ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Blind Techniques ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
In general, blind techniques not useful in children
Intubation - Confirmation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
REMINDER:  It’s Not Okay to Continue with Failed Techniques
Rescue Devices ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
LMA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
LMA Sizing Neonate / Infants < 5 kg 1 Infants 5-10 kg 1 ½  Infants / Children 10-20 kg 2 Children 20-30 kg 2 ½  Children/Small adults 30-50 kg 3 Large adult >70 kg 5 Adults 50-70 kg 4 Patient Size LMA Size
 
I-LMA ,[object Object],[object Object],[object Object],[object Object],[object Object]
Combitube ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bougie ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Other Toys ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Surgical Airways - Cricothyrotomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cricothyrotomy - Techniques ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cricothyrotomy - Complications ,[object Object],[object Object],[object Object],[object Object],[object Object]
Surgical Airways - Needle Cric ,[object Object],[object Object],[object Object],[object Object]
Needle Cricothyrotomy - Procedure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Needle Cricothyrotomy - Complications ,[object Object],[object Object],[object Object],[object Object],[object Object]
TTJV
What About RSI?
Rapid Sequence Intubation ,[object Object],[object Object],[object Object],[object Object]
RSI Medications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pretreatment -  Lidocaine ,[object Object],[object Object],[object Object],[object Object]
Pretreatment - Atropine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Induction - Etomidate ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Induction - Ketamine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Paralysis - Succinylcholine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Paralysis - Vecuronium ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ventilator Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ventilator Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ventilator Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ventilator Management ,[object Object],[object Object],[object Object],[object Object],[object Object]
Last but not least…
Broselow Tape ,[object Object],[object Object],[object Object],[object Object]
Broselow Tape ,[object Object],[object Object],[object Object],[object Object]
Broselow Tape ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Broselow Tape
Broselow Tape ,[object Object],[object Object],[object Object],[object Object]
Summary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Questions?
References ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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