Cuffed vs. uncuffed: studies show no increase in adverse effects if the pressure in the cuff can be monitored.
Uncuffed are safer for EMS providers to use unless patient requires high mean airway pressures.
If a cuffed ETT is used only inflate if leaking is noted around the cuff.
Deakers TW, Reynolds G, Stretton M, et. Al. Cuffed ETT in pediatric intensive care. L Pediatr 1994; 125:57-62 Khine HH, Corddry DH, Kettrick RG, et al. Comparrison of cuffed and uncuffed ETT in young children during general anesthesia. Anesthesiology 1997; 86:627-631
You arrive on scene to find a 4 year old male in the care of his mother. Mom reports the child has become progressively more ill over the last 24 hours. You observe the child drooling, sitting forward in a tripod position and refuses to sit back. He feels warm to the touch, RR: 36 with mild retractions, HR: 130, Skin: Pink, warm and dry with refill < 2 seconds, palpable peripheral pulses. He appears ill and talks with stridor (hot potato voice) What is the issue?
Croup is an infectious illness of the respiratory system involving the voice box and vocal cords. A harsh crowing sound ("stridor") during inhaling can be heard when the child's air passage becomes abnormally narrowed
It is the major cause of lower respiratory tract infection and hospital visits during infancy and childhood.
There is no vaccine.
Treatment is limited to supportive care, including oxygen.
In temperate climates there is an annual epidemic during the winter months
In the United States, 60% of infants are infected during their first RSV season, and nearly all children will have been infected with the virus by 2–3 years of age, 2–3% will develop bronchiolitis, necessitating hospitalization
RSV Treatment Treating respiratory syncytial virus bronchiolitis "remains a good example of therapeutic nihilism—nothing works except oxygen". Adrenaline, bronchodilators, steroids, and ribavirin confer "no real benefit“ Treatment is supportive care only, with fluids and oxygen until the illness runs its course
Albuterol may be used in an attempt to relieve any bronchospasm if present. Increased airflow, humidified and delivered via nasal cannula, may be supplied in order to reduce the effort required for respiration. Recent studies with hypertonic saline have shown that the "use of nebulized 3% HS is a safe, inexpensive, and effective treatment for infants hospitalized with moderately severe viral bronchiolitis" where "respiratory syncytial virus (RSV) accounts for the majority of viral bronchiolitis cases"
^ Jenny Handforth, Mike Sharland, Jon S Friedland. Editorial: Prevention of respiratory syncytial virus infection in infants. BMJ 2004;328:1026–1027 (1 May), doi:10.1136/bmj.328.7447.1026