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Pediatric Airway Management Considerations - Coggle Diagram
Pediatric Airway Management Considerations
Anatomy
HEAD
Large Occiput
padding is required under shoulders to align ear with sternal notch
short neck
Head movements can make a significant difference in ETT depth (2cm) - can cause inadvertent extubation or going right mainstem
PHARYNX
Floppy and omega-shaped epiglottis
The epiglottis is hard to pick up. Miller blade is used to pull back the entire structure rather than insertion into valecula
tongue is large relative to the mouth
LARYNX
vocal cords are slanted anteriorly & pink rather than white
Increases difficulty to visualize cords
Adapt by rotating the tube to the right or left to pass the anterior commissure and pass the cords
Crocoid cartilage is easily distorted with too much pressure
BURP should be done gently and with 1 forefinger instead of 2
Cricoid cartilage is the narrowest part of airway
FBAOs are more likely to be subglottic
LUNGS
Lung tissues are sensitive to large tidal volume or increased pressure
Suction pressures need to be lower (See ALS section)
Be careful to ventilate at 5-7mL/kg or risk causing barotrauma/pneumothorax
Physiology
Small residual volume
Higher metabolic rate
Become bradycardic with hypoxia
worsens hypoperfusion to myocardium and can lead to cardiac arrest
BLS
Airway and breathing are central to resuscitation
Good airwaymanagement is key,
NOT
necessarily intubation
Ventilate >1 min in between intubation attempts
The responder with the most pediatric airway experience should be on airway
ALS
ETT sizing
= (Age/4) + 3.5 OR diameter of little finger OR Broselow tape
Deep suction
Infants: 60-80mmHg
Children: 80-100mmHg
Suction catheter size < 1/2 internal diameter of ETT
Troubleshooting
Smaller ETTs are more likely to kink
Ventilations become exponentially more difficult with narrower lumen, so deep suction to maintain patency is even more important