Pediatric Airway ManagementDr.Indra Saputra SpA

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EarlyDefibrillationAdult Chain of SurvivalCPRALSEMS

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Pediatric Chain of SurvivalPreventionALSCPREMS

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Out-of-Hospital Cardiac ArrestSIDSTraumaSubmersionPoisoning

ChokingSevere AsthmaPneumonia

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In-Hospital Cardiac ArrestSepsisRespiratory FailureDrug Toxicity

Metabolic DisorderArrhythmias

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Pediatric Cardiorespiratory Arrests10%10%80%

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Hypoxia and HypercarbiaBradycardiaPediatric Cardiorespiratory Arrests

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Pediatric Chain of SurvivalPreventionALSCPREMS

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Respiratory DistressRespiratory FailureandRespiratory ArrestBLS

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Evaluation of Respiratory PerformanceRespiratory Rate and RegularityLevel of ConsciousnessColor of the Skin and Mucous MembranesRespiratory Mechanics

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Respiratory MechanicsHead BobbingNasal FlaringRetractionsGruntingStridorWheezing or Prolonged Exhalation

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Upper Airway Obstructionturbulence

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Lower Airway Obstruction

turbulence & wheezing

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AnatomyChildren are very different than adults !!!

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Anatomy :

AirwayNose TongueEpiglottis Vocal CordsLarynx

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Anatomy: LarynxNarrowest point = cricoid cartilageINFANTADULT

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PhysiologyTongue - Posterior DisplacementTongue Difficult to ControlEpiglottis Difficult to ControlVocal Cords Difficult IntubationTube size relative to Cricoid DiameterSmall Airway Edema causes High Resistance

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Effect Of EdemaPoiseuilles law

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Basic Life Support

A+B

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Two Steps Before1. Ensure the Safety of Rescuer and Victim ( the scene, gloves, barrier devices)

Partial CPR: Is Something Better than Nothing?

2. Stimulate and Check Responsiveness

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AirwayHead Tilt-Chin LiftJaw Thrust+ Tongue-Jaw Lift Maneuver (FBAO)

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Breathing Check Breathing

LookListenFeelRecovery PositionRescue Breathing

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Ventilation withOxygenMouth-to-Mouth ventilation provides only 17% O2Indicated to all seriously ill or injured patients even if pCO2 is highIf Possible humidify OxygenUse of reduced FiO2 is uncommon

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Devices to Monitor Respiratory FunctionPulse OxymetryEnd-Tidal CO2Arterial Blood Gas Analysis

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Oxygen Delivery SystemsOxygen MaskFace TentOxygen HoodOxygen TentNasal Canula

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Oropharyngeal AirwaySIZEPROPER POSITION

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Nasopharyngeal Airway

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Nasopharyngeal Airway

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Bag-Mask VentilationProper area for mask application

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Bag-Mask VentilationSellick Maneuver

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Laryngeal MaskContraindicated if gag-reflex is intactHigher success rateDoes NOT protect from aspirationDifficult to maintain during transport

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Intubation

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Intubation: IndicationsFailure to oxygenateFailure to remove CO2Increased WOBNeuromuscular weaknessCNS failureCardiovascular failure

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Tracheal Tube Children > 2 years:ETT size: (Age+16)/4ETT depth (lip): ETTsize x 3AgekgETT LengthNewborn3.53.593 mos6.03.5101 yr104.0112 yrs124.512

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Better in younger children with a floppy epiglottisStraightLaryngoscope Blades

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Laryngoscope BladesBetter in older children who have a stiff epiglottisCurved

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Intubation Technique

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Confirmation of ETT PlacementNO single technique is 100% reliableClinical ConfirmationChest X-rayCO2 DetectionEsophageal Detector Devices

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Clinical ConfirmationChest riseWater vapor seen inside tubeBreath sounds - lungBreath sounds epigastriumO2 Saturation

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Acute Deterioration after IntubationD.O.P.E: Displacement Obstruction Pneumothorax Equipment failure

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Inadequate Improvement after IntubationInadequate Tidal VolumeExcessive Leak Around The TubeAir Trapping and Impaired Cardiac OutputLeak or Disconnection in Ventilator SystemInadequate PEEPInadequate O2 Flow from Gas Source

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Thank You

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Percutaneous CricothyrotomyComplete UA Obstruction:FBAOSevere Orofacial InjuriesUpper Airway Infections

1Adult VF or Pulseless VTIf asystolic, mortality > 90%

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