156. Ped Airway Management

Question 1

What age do children’s airways become more anatomically like adults? 8

Question 2

Recommendations for aligning infant occiput? line through ext aud canal toant shoulder - horiz and paralal to bed<br></br>infant <6mo: shoulder roll<br></br>sm child 6mo - 5y: without need for support likely

Question 3

Major anatomic differences of peds vs adult airway anatomy? 7 1. large occiput and haed<br></br>2. large tongue<br></br>3. higher

Answer 3

anterior airway<br></br>4. Upper airway anatomy and narrow subglottic region<br></br>5. large tonsil and adenoids<br></br>6. small cricothyroid membrane<br></br>7. large stomach

dependence on diaphragm excursion for ventilation

Question 4

Based on differences in children

Answer 4

how does this have implications for airway management? -neck flex when lying supine so use a shoulder roll in young infants<br></br>-tongue can occlude airway so jaw thrust

oral/naso airway<br></br>-anterior airway needs to have appropriate laryngoscopy positioning prior<br></br>-upper airway is prone to dynamic collapse and inflamm so use cuffed tube<br></br>-small cricothyroid - so use needle cric<br></br>-large stomach so use oro or nasogastric tube for decompression as insufflcation of stomach in bmv can compromise ventilation

Question 5

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Question 6

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Question 7

What blad helps with floppy epiglottis? miller

Question 8

VC and glottis where in infants? C1

Question 9

VC and glottis where in age 7 c3-c4

Question 10

VC and glottis where in late adolescence c6

Question 11

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Question 12

Nasotracheal intubation - CI in what age group ? <10 given large tonsils and adenoids tend to bleed

Question 13

What are physiologic differences between kids and adults? 2 Kids:<br></br>1. high metabolic rate and low RFC means quick to desat when apneiuc<br></br>2. large ECF so many drugs are higher for kids and may act shorter

Question 14

Even if preox well

Answer 14

how long til kids go apneic?<br></br>ex: normally healthy 10kg child may fall below 90% in _ mins<br></br>sick infant desat in less than _min 3<br></br>1

Question 15

BMV a kid in between attempts for ETT when o2 gets to _% 95

Question 16

Equation to determine endotracheal tube: UNcuffed 4 + (age in years/4)<br></br><br></br>ex 4yoa: 4+ (4/4) = 5 uncuffed

Question 17

Equation to determine endotracheal tube: cuffed 4 + (age in years/4) - 0.5<br></br><br></br>ex: 4yoa: 5-0.5 = 4.5

Question 18

Depth of ETT: equation: 3 x uncuffed tube size = lip to tip distance (should be in mid trachea)

Question 19

Example for 4 year old kid - ETT distance? 4 + (4/4) = 5<br></br>x3<br></br>=15cm 

Question 20

Indications for pediatric intubation 4 1. inability to maintain or protect airway<br></br>2. inability to ox/vent<br></br>3. clinical deterioriation<br></br>4. high risk for transport

Question 21

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Question 22

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Question 23

What medications are helpful for pretreatment in peds airway? 1. atropine - prevent brady related to vagal tone<br></br>2. NOT ACTUALLY RECOMMENDED lidocaine - attenuate reflex sympathetic response in pt with incr ICP concern - though not really recommended?

Question 24

Assoc between which paralytic drug and bradycardia in kids? succ

Question 25

Etomidate in ped RSI: precautions in what states? sepsis
if use

Answer 25

give hydrocortisone

Question 26

Preferred sedative medication for kids with septic shock? ketamine

Question 27

High dose of succ in kids -what is it? 2mg/kg neonates and infant vs adol 1.5

Question 28

will you always see fasciulations in kids given succ? no because they may not have body mass to show it

Question 29

contraindications of succ myopathy - hyperk
burns 3d
similar to adults

Question 30

Adverse effects of succ hyperkalemia
masseter spasm
malignant hyperthermia

Question 31

Roc dose for kids 1.2mg/kg

Question 32

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Question 33

Name 5Ps of advanced airway management 1. Prep
2.Preox
3. Post
4. Place tube
5. Perform etco2/check/post intub management

Question 34

how to preox infants/children -  1 to 2L/min/ year of age to max 15L/min

Question 35

How to use a miller blade? straight blade beneath epiglottis

Answer 35

lift up and bring VC into line of sight

Question 36

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Question 37

Recommendations for placing miller blade "*In younger children

Answer 37

emergency clinicians

Question 38

may tend to insert the laryngoscope blade too deeply

Answer 38

resulting in ret-

Question 39

roglottic or esophageal placement and unnecessary airway trauma.

Question 40

With this in mind

Answer 40

emergency clinicians should start the intubation

Question 41

procedure by placing the laryngoscope blade just to the base of the

Question 42

tongue and lift up to view the airway anatomy. Identify structures pro-

Question 43

gressively

Answer 43

first directly identifying the base of the tongue and the epi-

Question 44

glottis prior to insertion of the straight blade underneath the epiglottis

Question 45

or the curved blade into the vallecula to visualize the vocal cords. If

Question 46

no laryngeal structures are identified due to inadvertent deep inser-

Question 47

tion

Answer 47

the blade should be slowly withdrawn under visualization ## Footnote and

Question 48

the cords or the epiglottis will often fall into view."

Question 49

How to manuever around the superior position of larynx in children? stylet

Question 50

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Question 51

Airway rescue in peds - sga? "

Question 55

SGDs have been demonstrated to be a reli-

Question 56

able way to establish oxygenation and gas exchange in the normal and

Question 57

difficult pediatric airway

Answer 57

as well as during resuscitation. 

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Question 61

Needle based rescue procedure - ? strategy vs vent oxygenation

Question 62

How to perform a needle cric for peds pt can't intubate cannot ventilate? 1. 14 gauge need through anterior neck into cricothyroid membrane (can be diff to find)
2. needle removed

Answer 62

catheter conected to adaptor for 3.0mm ETT
3. then ett connected to bag
if no 3.0 mm ett - cant place a 3ml syringe with plunger removed to cather
4. squeeze bag with prolonged exhalation

Question 63

when are kids old enough to get a surgical cric? >8

Question 64

"

5. Following the administration of succinylcholine in a 7-year-old boy with respiratory distress, severe masseter spasm is noted. Which of the following medications should be administered to terminate this spasm?

a. Diazepam
b. Fentanyl
c. Repeated dose of succinylcholine d. Rocuronium
e. Thiopental 

" D roc