Advanced management of the airway and ventilation Flashcards
What is the most common cause of cardiorespiratory arrest in children?
Upper airway obstruction, resulting in hypoxia and acidosis
How could you recognise an airway obstruction?
In a conscious child airway obstruction, maybe demonstrated by difficulty in breathing or increased respiratory effort.
In both conscious and unconscious children, there may be additional respiratory noises if the obstruction is partial, where is respiration will be silent, if there is a complete obstruction .
What is the most effective way to detect airway obstruction in children?
Look for chest and abdominal movements
Listen for airflow at the mouth and nose as well as additional noises
Feel the airflow at mouth and nose
What are some basic techniques to optimise the airway?
In conscious children, they should be supported in a comfortable position. They naturally assume themselves to optimise the airway. & high flow oxygen should be given
In unconscious children, the patency of airway needs to be optimised immediately. This means positioning the head with head tilt and chin lift or jaw first manoeuvre.
 suctioning for secretions and vomit
How do you measure and oropharyngeal airway (Guedel)?
When lead against the side of the face has a lengthy call from the patients in sizes to the angle of the Jaw
What are we adjunct could you use for a conscious child?
Nasopharyngeal airways are tolerated in conscious children, then oropharyngeal airways
When providing positive pressure ventilation for an infant/child, what should the respiratory rate be?
12-30 per min
30 per min for newborn
Lower rates of ventilation are used for children and infants who have an advanced airway in place during cardiorespiratory arrest
What size laryngeal mask airway should be used for different ages
Neonates <5kg = LMA size 1, 4ml (max cuff volume)
Infants 5-10kg = LMA size 1.5, 7ml (max cuff volume)
Infants 10-20kg = LMA Size 2, 10ml (max cuff volume)
Children 20-30kg = LMA size 2.5, 14ml (max cuff volume)
Children 30-50kg = LMA Size 3, 20ml (max cuff volume)
i-gel size selection based on age
1 - Neonates <5kg
1.5 - Infant 5-12kg
2 - Infant 10-25kg
2.5 - Children 25-35kg
3 - Children 30-60kg
What age range or straight laryngscope blades used for
Straight blades are usually preferred funny, and it’s an infant under a year
Which age range are curved blades (laryngoscope) preferred
Curved blade up third in children and adolescents
How would you know if the tracheal tube is in the right place?
Clear visualisation of cheap passing through glottis
End tidal CO2 monitoring
Symmetrical, chest, rise and fall
Why natural air entry in for zones with each ventilation
Absence of bubbling noise over stomach upon ventilation
Chest x-ray - tip should ideally be between T2 and T3.
What does dopes stand for and when is it used?
Is the condition of an intubated child deteriorates consider various possibilities recalled by the acronym DOPES
D. – displacement of the tracheal tube
O. - obstruction of artificial airway, potentially secretions or kinking of tracheal tube
P. - pneumothorax from excessive BMV pressure, rib fracture
E. - equipment failure, for example, disconnected oxygen supply
S - stomach distension, following expired air or bag mask
What emergency anaesthesia can be used for intubation?
For analgesia -  Alfentanil, fentanyl
Anaesthetic agent - ketamine, propofol, sevoflurane, thiopentone
Neuromuscular blocking drug - rocuronium, suxamethonium
What is a cricothyroidotomy?
Needle cricothyroidotomy is last resort emergency technique in cases of upper airway obstruction (laryngeal obstruction due to oedema, foreign body or major facial trauma)
It is a technique of default when ventilation by BMV or supraglottic airway device, and TT intubation have failed.
It can be performed with a large bore over the needle cannula, a syringe is connected to the cannula and gently aspirated as it punctures a prominent tracheal ring or cricothryroid membrane.
