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2013 Pediatric Fellows Boot Camp_Adjuncts BMV & LMA
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2013 Pediatric Fellows Boot Camp_Adjuncts BMV & LMA

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  • Important differences: relatively larger tongue; higher opening, taller/more narrow epiglottis (can make more floppy?), narrowest portion is cricoid cartilage (this picture doesn’t do justice)
  • 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!
  • Transcript

    • 1. Pediatrics Matthew Musick, MD Fellows Boot Camp 2013 Airway Adjuncts, Bag Mask Ventilation, and Laryngeal Mask Airways
    • 2. Page 2 Pediatrics Objectives •Be able to choose proper size oral/nasal airway, facemask (for BMV), and LMA according to anatomic landmarks and patient age/size •Learn complications from various airway maneuvers ‐5 complications related to use of airway adjuncts ‐3 complications related to BMV ‐3 complications related to LMAs
    • 3. Page 3 Pediatrics Pediatric vs Adult Airway Infant Adult
    • 4. Page 4 Pediatrics Positioning (“sniffing”)
    • 5. Page 5 Pediatrics Positioning - Infant R
    • 6. Page 6 Pediatrics Positioning - Comparison
    • 7. Page 7 Pediatrics Obstruction
    • 8. Page 8 Pediatrics Options – Chin lift
    • 9. Page 9 Pediatrics Options – Jaw Thrust
    • 10. Page 10 Pediatrics Options – Oral Airway
    • 11. Page 11 Pediatrics Oral Airway
    • 12. Page 12 Pediatrics Oral Airway – Too Small
    • 13. Page 13 Pediatrics Oral Airway – Too Large
    • 14. Page 14 Pediatrics 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
    • 15. Page 15 Pediatrics Oral Airway Complications •Yak*$%! (ie the gag reflex) •Obstruction (not really your desired effect) •Laryngospasm •Tooth/mouth injury
    • 16. Page 16 Pediatrics Nasopharyngeal Airways •Same concept of relieving tongue obstruction •Better tolerated than oral airway if patient semi- conscious or awake •Contraindicated with: ‐Significant facial trauma (esp basilar skull fracture) ‐Severe coagulopathy
    • 17. Page 17 Pediatrics Size Selection
    • 18. Page 18 Pediatrics Nasopharyngeal Airway Insertion •Don’t forget the lube!
    • 19. Page 19 Pediatrics 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!
    • 20. Page 20 Pediatrics Equipment •Self inflating reservoir bag, unidirectional valve, standard mask connector, oxygen hook-up ‐Manometer, PEEP valve •Different size masks
    • 21. Page 21 Pediatrics 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)
    • 22. Page 22 Pediatrics E-C Hold
    • 23. Page 23 Pediatrics Successful BMV •Chest rise •Chest rise •Chest rise •Increased O2 sats, auscultation, condensation in mask
    • 24. Page 24 Pediatrics 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
    • 25. Page 25 Pediatrics Laryngeal Mask Airway •Many uses/indications for our anesthesia colleagues •Rescue airway device in PICU •Supraglottic airway that can be placed “blindly” but is temporary in nature
    • 26. Page 26 Pediatrics LMA
    • 27. Page 27 Pediatrics LMA
    • 28. Page 28 Pediatrics LMA Notes •Size selection is based on weight – look at package! •It will “pop up” slightly after cuff is inflated if seated correctly •Don’t forget the lube
    • 29. Page 29 Pediatrics LMA Insertion •Few methods… •Forefinger guiding technique
    • 30. Page 30 Pediatrics LMA Insertion •Rotational method ‐Similar to oral airway rotation ‐“Cuff” is pointed up towards palate ‐After advancing past the tongue, you rotate 180 degrees
    • 31. Page 31 Pediatrics LMA Insertion •Just stick it in •Works best for curved LMA
    • 32. Page 32 Pediatrics LMA Complications •Aspiration (although much less than traditionally feared) •Gagging and possibly laryngospasm •Difficult to achieve high peak inspiratory pressures
    • 33. Page 33 Pediatrics Questions???