Flashcards in Airway and Intubation ✅ Deck (57)
What is true of the airways in children compared to adults?
There are many anatomical airway differences between infants, children, and adults, and the younger the child, the more pronounced the difference
What is the importance of the difference in childrens airways?
It has relevance to emergency care, particularly airway opening manoeuvres, airway adjuncts, and endotracheal intubation
Why can life threatening airway obstruction develop rapidly in children?
As the airway is already narrow, and further airway narrowing from any cause increases resistance according to Pouseuille's law
How is Pouseuille's law applied to airways?
As resistance is inversely proportional to the fourth power of the radius, a small reduction in an already small airway radius will result in a large increase in resistance
What can neck flexion or overextension lea to in infants?
Airway obstruction by tracheal compression
Why can neck flexion or overextension lead to airway obstruction in infants?
Due to the relatively large head and short neck in infants
What else can cause airway obstruction in infants?
The relatively large tongue
When in particular can an infants tongue cause airway obstruction?
If there is a reduced level of consciousness
What other problem might the tongue cause?
May impede the view at laryngoscopy
What manoeuvres are used to open the airway in children?
- Head tilt/chin lift
- Jaw thrust
How do airway manoeuvres used in children work?
They apply anterior tension to the hyoid bone and draw the epiglottis away from the posterior pharyngeal wall, opening the pharynx
In addition to drawing the epiglottis away from the pharyngeal wall, how else does jaw-thrust improve airway potency?
It pulls the tongue, which may cause airway obstruction, away from the palate and opens the oropharynx
What care must be taken when performing airway opening manoeuvres in children?
When positioning the fingers, as the floor of an infants mouth is easily compressible
What is it important to do when performing head tilt/chin lift in an infant?
Control the degree of head tilt to avoid airway narrowing due to overextension of the head and neck
What head position is preferred when opening the airway in an infant?
Why is a neutral position preferred when opening the airway in an infant?
Due to the large head and short neck
What head position is used when opening the airway in a child?
The sniffing position
When is the head tilt/chin lift manoeuvre contraindicated?
If there is a history of trauma
Why is the head tilt/chin lift manoeuvre contraindicated if there is history of trauma?
It may exacerbate cervical spine injury
What is the purpose of an oropharyngeal airway, or Guedel airway?
It creates an open channel between the mouth to the posterior pharyngeal wall
When are oropharyngeal airways used?
Only in infants and children with reduced level of consciousness
Why are oropharyngeal airways only used in infants and children with reduced level of consciousness?
As they may cause choking or vomiting if the gag reflex is present
How are oropharyngeal airways sized?
Measuring distance between anterior nares and tragus of ear
What is the problem with airway adjuncts that are too small?
May be ineffective
What is the problem with airway adjuncts that are too large?
May cause laryngospasm
What is often tolerated better than an oropharyngeal airway?
A nasopharyngeal airway
What complication may arise from insertion of a nasopharyngeal airway?
Haemorrhage from the vascular nasal mucosa
What is the effect of haemorrhage from vascular nasal mucosa caused by nasopharyngeal airway?
Worsens airway obstruction
When is a nasopharyngeal airway contraindicated?
Basal skull fracture