App aw adj&bvm

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  • Different motif, more science
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  • May be relieved by jaw thrust or chin lift
  • 2 options – one measured to tragus of ear. Other to mandible angle
  • Careful not to compress soft-tissue and airway!
  • App aw adj&bvm

    1. 1. Pediatric Airway Management Pediatrics
    2. 2. Objectives •By the end of this PowerPoint the learner will be able to: ‐ Restate at least… •5 complications associated with the use of airway adjuncts •3 complications associated with bag-valve-mask ventilation (BVM) ventilation ‐ Choose an appropriately sized airway adjunct and BMV facemask according to anatomic landmarks Pediatrics Page 2 xxx00.#####.ppt 11/14/13 09:29 PM
    3. 3. Positioning (“sniffing”) Pediatrics Page 3 xxx00.#####.ppt 11/14/13 09:29 PM
    4. 4. Positioning - Infant R Pediatrics Page 4 xxx00.#####.ppt 11/14/13 09:29 PM
    5. 5. Positioning - Comparison Pediatrics Page 5 xxx00.#####.ppt 11/14/13 09:29 PM
    6. 6. Obstruction Pediatrics Page 6 xxx00.#####.ppt 11/14/13 09:29 PM
    7. 7. Options – Chin lift Pediatrics Page 7 xxx00.#####.ppt 11/14/13 09:29 PM
    8. 8. Options – Jaw Thrust Pediatrics Page 8 xxx00.#####.ppt 11/14/13 09:29 PM
    9. 9. Options - Oral Airway •Prevents upper airway obstruction •May make Bag-valve-mask ventilation more effective •Should not be used in semi comatose of alert patients Pediatrics Page 9 xxx00.#####.ppt 11/14/13 09:29 PM
    10. 10. Options – Oral Airway Pediatrics Page 10 xxx00.#####.ppt 11/14/13 09:29 PM
    11. 11. Oral Airway Pediatrics Page 11 xxx00.#####.ppt 11/14/13 09:29 PM
    12. 12. Oral Airway – Too Small Pediatrics Page 12 xxx00.#####.ppt 11/14/13 09:29 PM
    13. 13. Oral Airway – Too Large Pediatrics Page 13 xxx00.#####.ppt 11/14/13 09:29 PM
    14. 14. Insertion Technique •First open mouth (can use cross finger scissor technique) •Option # 1 – push tongue down w/ tongue depressor and insert “straight in” •Option # 2 – insert “upside down” and then rotate 180 degrees as oral airway is being advanced to back of oropharynx Pediatrics Page 14 xxx00.#####.ppt 11/14/13 09:29 PM
    15. 15. Oral Airway Complications •Yak*$%! (ie the gag reflex) •Aspiration •Obstruction (not really your desired effect) •Laryngospasm •Tooth/mouth injury Pediatrics Page 15 xxx00.#####.ppt 11/14/13 09:29 PM
    16. 16. Nasopharyngeal Airways •Same concept of relieving tongue obstruction •Better tolerated than oral airway if patient semiconscious or awake •Contraindicated with: ‐ Significant facial trauma (esp basilar skull fracture) ‐ Severe coagulopathy Pediatrics Page 16 xxx00.#####.ppt 11/14/13 09:29 PM
    17. 17. Nasopharyngeal Airways Complications •Laryngospasm and coughing (esp if too long) •Nosebleeds •Sinus infection Pediatrics Page 17 xxx00.#####.ppt 11/14/13 09:29 PM
    18. 18. Size Selection Pediatrics Page 18 xxx00.#####.ppt 11/14/13 09:29 PM
    19. 19. Nasopharyngeal Airway Insertion •Don’t forget the lube! Pediatrics Page 19 xxx00.#####.ppt 11/14/13 09:29 PM
    20. 20. Bag Mask Ventilation •True life saving technique •Can oxygenate and ventilate •Helpful during intubation ‐ Can “improve” patient so that intubation is less strenuous ‐ Can “rescue” patient if intubation attempt fails •May need airway adjunct and two people!!! Pediatrics Page 20 xxx00.#####.ppt 11/14/13 09:29 PM
    21. 21. Equipment •Self inflating reservoir bag, unidirectional valve, standard mask connector, oxygen hook-up ‐ Manometer, PEEP valve •Different size masks Pediatrics Page 21 xxx00.#####.ppt 11/14/13 09:29 PM
    22. 22. Mask Size and Fit •Extend from bridge of nose to chin (covering mouth and nose) •Inflatable rim can help assure seal •“E-C” hold is preferred technique ‐ Thumb and forefinger form C on top of mask ‐ Middle/ring fingers on ridge of mandible (chin lift) ‐ Pinky behind angle of mandible (jaw thrust) Pediatrics Page 22 xxx00.#####.ppt 11/14/13 09:29 PM
    23. 23. E-C Hold Pediatrics Page 23 xxx00.#####.ppt 11/14/13 09:29 PM
    24. 24. Successful BMV •Chest rise •Chest rise •Chest rise •Increased O2 sats, auscultation, condensation in mask Pediatrics Page 24 xxx00.#####.ppt 11/14/13 09:29 PM
    25. 25. Complications of BMV •Excessive air in stomach ‐ Aspiration risk ‐ Decreases lung volume/requires higher PIPs •Corneal abrasions •Injury to lips/gums and nasal bridge •Excessive bagging due to user exuberance Pediatrics Page 25 xxx00.#####.ppt 11/14/13 09:29 PM
    26. 26. NOW WATCH IT DONE Pediatrics
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