It deals about how to access the airway

1. Airway
ETAT+ Sierra Leone 2020

2. Learning Objectives
At the end of the session you will be able to:
• Identify the importance of an open (patent) airway
• Assess a child’s airway
• Maintain an open airway in an infant and child
• Manage a choking child
• Manage common airway disorders

3. Airway Anatomy
• Airway consists of the
• Nose
• Pharynx
• Larynx
• An open (also known as
patent) airway is
required to get oxygen
into the lungs
• Partial or complete
obstruction causes
children to become
rapidly unwell

4. How to assess the Airway
• Look
• Listen
• Consider is the child alert enough to maintain their airway?
• Airway at risk in children with AVPU of P or U
- Vomit
- Secretions
- Foreign body
- Drooling
- Stridor
- Noisy breathing
- Choking
- Hoarse voice
- Snoring

5. Stridor
• Harsh noise when breathing in (inspiratory)
• https://www.youtube.com/watch?v=oeoAze-CHng

6. Airway in an Unconscious Child
• Tongue falls back and blocks the airway

7. How to manage the Airway
• Suction
• Positioning
• Jaw thrust
• Airway adjuncts
• Oxygen

8. • Suction can remove vomit, secretions, blood or a small
foreign body
• Only suction as far as you can see with a torch or
laryngoscope
• Do not do a ‘blind sweep’
Airway Management: Suction

9. Children > 1 year old
Sniffing position
Head tilted slightly with chin lifted
to point to the ceiling
Airway Management: Positioning
Infants < 1 year old
Neutral position
Face parallel to the couch and
nose pointing to the ceiling

10. Airway Management: Jaw Thrust
• Put pressure behind the angle of the jaw with your
fingers to lift jaw up
• Moves jaw and tongue upwards to help unblock airway
• Can be used in children with suspected neck trauma
without head tilt

11. Airway Management: Adjuncts
• Hold tongue forward to keep the airway open
• Oropharyngeal (Guedel) airway
• Put into the mouth
• Sized by measuring from front of incisors to angle of
the jaw

12. Airway Management: Adjuncts
• Nasopharyngeal airway
• Put into nose
• Sized by measuring from the nostril to ear
• Do not use in head trauma
• May be better tolerated in more conscious patients

13. Airway Management: Other Points
• Oxygen
• Should be given to children with airway obstruction
• Titrate to oxygen saturations ≥90% if possible
• Recovery position
• Unconscious children who are breathing with an open airway
should be placed in the recovery position
• Helps reduce the risk of vomit entering the lungs
• Consider NG tube
• Aspirate stomach contents
• Reduce risk of vomit entering lungs

14. Neck Trauma
• If you suspect trauma affecting the neck or spine, do not
move the head or neck as you treat the child
• Moving could cause further damage
• Stabilise the child’s neck
• Keep the child lying on their back
• Support the child’s head either side eg with 1L IV fluid bags
• Tape across the child’s forehead and chin to the bed/board
• Jaw thrust only to open airway
• Do not use the sniffing position.

15. Choking Child
Assess severity
Good cough
Poor cough
Encourage Cough
Continue to check for
deterioration to poor cough
or relief of obstruction
Conscious
5 back slaps
5 abdominal/chest thrusts
chest for infant < 1 year
abdominal for child > 1 year
(stop when obstruction relieved)
Unconscious
Open airway
5 rescue breaths
Start CPR (BLS)

16. Choking Infant
Management of infant under 1 year old
Back Slaps:
• Support baby’s neck with one
hand
• Position baby’s face down with
head lower than body
• Apply 5 back slaps between
shoulder blades with one hand

17. Choking Infant
Management of infant under 1 year old
Chest Thrusts:
• Turn baby over, face up and
support the neck
• Apply 5 chest thrusts using 2-3
fingers on the lower sternum just
below nipple line
• Compress around 1 inch deep

18. Choking Child
Management of child over 1 year old
Back Slaps:
• Support the child to lean
forwards
• Apply 5 back slaps between the
shoulder blades with the palm of
one hand

19. Choking Child
Management of child over 1 year old
Abdominal Thrusts (Heimlich Manouvre):
• Stand behind child
• Put both arms around the upper body
of the child
• Make sure they are bending forwards
• Clench your fist and place it between
the belly button and the bottom of their
breastbone
• Grasp your fist using your other hand
and then pull sharply inwards and
upwards
• Repeat up to 5 times

20. Choking Child
• Stop back slaps and chest/abdominal thrusts when
obstruction relieved
• Or repeat until state of consciousness changes

21. Causes of Airway Obstruction
• Unconsciousness
• Foreign body
• Infection
• Anaphylaxis
• Secretions / mucus
• Burns
• Tumour / mass

22. Airway in an Unconscious Child
• Tongue falls back and blocks the airway
• Manage with positioning, jaw thrust or airway adjuncts

23. Foreign Body

24. Airway Infection: Epiglottitis
Epiglottis
Oesophagus
(to stomach)
Trachea
(to lungs)
Tongue
• Bacterial infection of epiglottis causing swelling

25. Airway Infection: Epiglottitis

26. Airway Infection: Epiglottitis
• Bacterial infection of epiglottis causing swelling
• Presentation:
• Unwell child
• Fever
• Soft stridor
• Drooling
• Sore throat

27. Airway Infection: Epiglottitis
• Management:
• Keep the child calm
• Oxygen
• IV Ceftriaxone 80mg/kg OD
• IV Dexamethasone 0.15mg/kg, max 4 doses in 24 hours
• IV maintenance fluids
• Analgesia
• Prevent by routine immunisation for Haemophilus
Influenzae

28. Airway Infection: Croup
• Viral infection of larynx, trachea and bronchi
• Presentation:
• Commonly mild: hoarse voice, barking cough, stridor
when child upset, fever
• Rarely severe: stridor at rest, respiratory distress with
chest indrawing

29. Airway Infection: Croup
• Management:
• Keep the child calm
• Sit the child up
• Only give oxygen if hypoxic - might upset child
• Dexamethasone 0.6mg/kg oral
• Antibiotics not required (it is a virus)
• Only give antibiotics if the diagnosis is in doubt

30. Airway Infection: Tonsillitis
Presentation:
• Commonly causes sore throat, pain on
swallowing and fever with no airway obstruction
• Rarely causes airway obstruction with severe
tonsillitis or peritonsillar abscess:
• Child looks sick
• Drooling – too painful to swallow
• Fever
• Dehydration

31. Airway Infection: Tonsillitis
Tonsils with pus on
https://curehows.com/wp-content/uploads/2018/01/white-spots-tonsils.jpg

32. Airway Infection: Tonsillitis
• Sore throat with no airway obstruction
• Treat with Oral Penicillin V or Erythromycin for 10 days
• Severe tonsillitis or peritonsillar abscess causing airway
obstruction
• Prop child up in bed
• May require oxygen
• IV Ceftriaxone 80mg/kg OD
• IV Dexamethasone 0.15mg/kg, max 4 doses in 24 hours
• IV maintenance fluids
• Analgesia
• May require incision and drainage if ENT available

33. Anaphylaxis
• Severe allergic reaction
• Common causes are antibiotics, blood products, nuts
• Presentation:
• Swelling of lips, mouth, tongue
• Stridor (upper airway)
• Wheeze (lower airways)
• Collapse
• Urticarial rash
• Vomiting, diarrhoea
• Abdominal pain

34. Anaphylaxis
Management:
• Oxygen
• Get IV or IO access
• IM Adrenaline 1:1000
• IV Hydrocortisone 4mg/kg (max 100mg)
• IV Fluid bolus for shock
• Stop the cause eg antibiotics
Age
IM Adrenaline Dose
of 1:1000 solution
Under 6 years 0.15 mls
6 – 12 years 0.3 mls
Over 12 years 0.5 mls

35. Questions?

36. Summary
• Airway should be assessed and managed first
because it can kill quickest
• Stridor, noisy breathing, choking and drooling are
signs that the airway is at risk
• Open the airway by positioning the head in a
neutral position for children <1 year old (infants)
• Open the airway by positioning the head in a
sniffing position for children >1 year old
• Jaw thrust and airway adjuncts can also help
open the airway

37. Thank you so much for
your attention!