Pediatric Airway
Management

Pediatrics
Objectives
•By the end of this PowerPoint the learner will
be able to:
‐ Restate at least…
•5 complications associated wit...
Positioning (“sniffing”)

Pediatrics

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Positioning - Infant

R

Pediatrics

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Positioning - Comparison

Pediatrics

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Obstruction

Pediatrics

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Options – Chin lift

Pediatrics

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Options – Jaw Thrust

Pediatrics

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Options - Oral Airway
•Prevents upper airway obstruction
•May make Bag-valve-mask ventilation more
effective
•Should not b...
Options – Oral Airway

Pediatrics

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Oral Airway

Pediatrics

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Oral Airway – Too Small

Pediatrics

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Oral Airway – Too Large

Pediatrics

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Insertion Technique
•First open mouth (can use cross finger scissor
technique)
•Option # 1 – push tongue down w/ tongue
de...
Oral Airway Complications
•Yak*$%! (ie the gag reflex)
•Aspiration
•Obstruction (not really your desired effect)
•Laryngos...
Nasopharyngeal Airways
•Same concept of relieving tongue obstruction
•Better tolerated than oral airway if patient semicon...
Nasopharyngeal Airways Complications
•Laryngospasm and coughing (esp if too long)
•Nosebleeds
•Sinus infection

Pediatrics...
Size Selection

Pediatrics

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Nasopharyngeal Airway Insertion

•Don’t forget the lube!
Pediatrics

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Bag Mask Ventilation
•True life saving technique
•Can oxygenate and ventilate
•Helpful during intubation
‐ Can “improve” p...
Equipment
•Self inflating reservoir bag, unidirectional valve,
standard mask connector, oxygen hook-up
‐ Manometer, PEEP v...
Mask Size and Fit
•Extend from bridge of nose to chin (covering
mouth and nose)
•Inflatable rim can help assure seal
•“E-C...
E-C Hold

Pediatrics

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Successful BMV
•Chest rise
•Chest rise
•Chest rise
•Increased O2 sats, auscultation, condensation
in mask

Pediatrics

Pag...
Complications of BMV
•Excessive air in stomach
‐ Aspiration risk
‐ Decreases lung volume/requires higher PIPs

•Corneal ab...
NOW WATCH IT DONE

Pediatrics
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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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