July 19, 2012 by EmerJencyWEBB
Had a great airway lab today. A few pearls I picked up today to document for later study/review…
- position of comfort is key in metastable airways
- remember the key anatomic differences in peds vs. adults
- shoulder roll for positioning
- most use cuffed tubes for all kids these days
- prophylactic pretreatment with atropine is not typically done anymore
- may have to choose one tube size smaller in kids with swollen structures to prevent complications at time of extubation (i.e. subglottic stenosis)
- Great PDF about Pediatric Emergency Airway Management.
- The procedure is easy. The decision is hard. Once you make that decision, the rest will fall into place.
- The finger can see better than your eyes (we did this procedure with greased up glasses on). Be able to do this procedure blindly.
- If you use ETT, choose 5.0 or 6.0
- use fast 1-2 second bursts
- exhalation is passive for 3-5 seconds
- if jet insufflator is not available, may take large angiocath for tracheal puncture, and add the plastic connector from a 3.0 ETT to ventilate with BVM
- More on Jet Insufflation
- Practice, practice, practice
- Remember to load ETT before you go down (poor form if you find cords, but can’t pass a tube)
- Keep an awake airway algorithm (drugs, dosages, pre-meds, etc…) in your bag of tricks at all times.
- It is possible to bougie through a King Airway, and change out to ETT
- Remember to lube the ILMA up prior to the procedure (makes a big difference)
- Don’t get too close to glottis with glidescope, enhance your view by backing up a little to see your tube better.
- Get in the habit of touching every vent you put your patient on.
- Know the critical alarm sounds well, and respond to them like a code blue
- Volume A/C is a great mode for the ED patient
- However, if the pt is spontaneously breathing and intubated for non-respiratory reason, there is nothing wrong with pressure support ventilation and 40% FIO2 (not everyone needs 100% to start out)
- For the severe asthmatic/COPD, decrease the respiratory rate, up the flow rate to 80-100, increase the expiratory time, know the pressure/volume curve for auto-peep and several treatments for this (i.e. they may do well with a PEEP of 0)
Link goes to my favorite airway checklist I’ve found and have been using for myself.
Credit to R. Strayer / S. Weingart / P. Andrus / R. Arntﬁeld Mount Sinai School of Medicine / v13 / 7.8.2012