Peds Airway

-upper airway differences: floppier airway, bigger tongue

lung and chest differences: peds pts have much more compliant chest wall (cartilaginous), so have minimal RV (FRC). Ex: as soon as you stop bagging, pt’s chest wall collapses and sats drop fast.

Bagging: slow and hard. Apply PEEP valve to ~10. Kids can tolerate hypercapnia but really need the oxygenation.
-rely on exam: good chest rise and improvement in color (pulse ox lags ~20s)
-#1 = good seal. Bring face up to mask.
-if still see poor chest rise, r/u (floppy) airway obstruction by placing oral airway
-keep pop-off pressure valve open/unlocked to release excess pressure
—the ONLY time to lock it (and deliver high inspiratory pressures >40s) as a last resort if still not getting good chest rise (esp if suspect ARDS

Screen Shot 2017-10-14 at 11.35.46 AM

Intubation:
-if potential airway obstruction, try to avoid paralyzing pt and time insertion of ETT with vocal cord opening
-if lung (rather than airway) problem, can bag indefinitely while call for help
—-it’s ok to take can take first look to get an idea of the airway, then bag back up once sats drop below 90% and then look again. Bag between attempts when SpO2 drops!
-for sticky mucous membranes, *rinse ETT with saline* (rather than use excess lube that may clog up tiny ETT)
-careful not to go too deep with laryngoscope! The blade actually gets in the way impedes your ability to insert the ETT. Put the blade in in superficially and pull up and outward to get your view
-consider using Miller in age <2y

http://www.emdocs.net/the-pediatric-airway-pearls-and-pitfalls/

 

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