Post-intubation steps are similar between pediatric and adult patients. Connect a 14 gauge to 3.0 ET tube adapter.Īt this point the patient can be oxygenated but very poorly ventilated, with approximately 40-60 minutes max until a more definitive airway is necessary.
Insert the needle and advance at a caudal angle while withdrawing until you see air bubbling, confirming placement. Connect a 14 gauge needle to a syringe with 3-5 cc of sterile saline.Identify the cricothyroid membrane, found inbetween thyroid and cricoid cartilage, and prepare a sterile field.To perform needle cricothyroidotomy, follow these steps: 2 When attempting a needle cricothyroidotomy, be wary of the compressibility of the cricoid, as there is a larger risk of puncturing through to the esophagus compared to adults. Just as in adults, managing the pediatric airway requires a familiarization with the equipment and a stepwise approach that begins with assessment of airway patency followed by identifying an oxygenation or ventilation issue.įor the child in respiratory distress, initial interventions include low-flow oxygen delivery systems ( 8 years old should be implemented. The steps to the pediatric airway parallel that of an adult. This article will review some of the basics of the management of the pediatric airway (including anatomical differences, initial interventions, definitive airways, medication selection, ventilator settings, and difficult airways) in the hopes of somewhat lessening that anxiety. This anxiety can be heightened when facing a pediatric patient in respiratory distress and a potentially difficult airway. You instruct the nurse to give 20 cc/kg of fluids.Īs emergency physicians-in-training, we can feel uncomfortable when caring for critically ill pediatric patients.
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The patient is administered nebulized albuterol, while IV access, blood cultures, and a portable chest X-ray are obtained. You have the nurse start blow-by with no improvement in WOB or O2 saturation. Nasal suctioning only improves oxygen (O2) saturation to 88% with no change in work of breathing (WOB). On exam, you note upper airway congestion, nasal flaring, subcostal retractions, abdominal breathing, and bilateral wheezing. The infant is placed on a monitor and his respiratory rate is 70, with an oxygen saturation of 86%, a heart rate of 180, and a temperature of 102.9 F. His past medical history is significant for 34 weeks gestation, and a 2 day NICU stay. It is mid-December and a mother brings in her 6-month-old boy because of worsening respiratory distress and decreased energy and appetite over the past 3 days. The X-ray tech comes by to show you the image, and while you notice a possible foreign body the nurse calls you over for help. After albuterol and nebulized epinephrine, no change is noted on exam. You order nebulized epinephrine along with a portable chest and neck X-ray. Your differential includes croup, early epiglottitis, foreign body, reactive airway disease and early retropharyngeal abscess. There are no other pertinent exam findings, but the dad tells you the patient gets frequent upper respiratory infections for which she sometimes requires albuterol. When you walk into the room, you observe a mildly tachypneic patient, with inspiratory stridor at rest and clear nasal discharge. In triage the patient is given albuterol and placed on a monitor. You ask the nurse to administer nebulized epinephrine while you grab the pediatric airway cart and contact the "on-call" anesthesiologist.Ī 4-year-old, fully vaccinated girl is brought in by her father because of an acute onset of cough and wheeze since this morning. You are unable to immediately obtain a history from the mother because of a language barrier. Oxygen saturation is 88% on room air, heart rate is 165, respiratory rate is 55, and auricular temperature is 39.0 C. You note the child to have inspiratory stridor and to be tripoding. The nurse quickly brings the child into the critical care bay because of respiratory distress and begins placing the child on a monitor. This article reviews the basics of managing the pediatric airway, which has key differences from the adult airway.Ī 2-year-old boy from Ecuador is brought into your community ED. Critically ill pediatric patients can make physicians-in-training nervous - and that anxiety is heightened when it comes to a pediatric patient in respiratory distress.
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