Pediatric:

Universal Airway

 

 Assess for Adequacy:

 

  • Rate
  • Effort
  • SPO2 >92%
  • Inadequate effort/rate
  • Upper Airway Obstruction
  • Hypoxia; 92% SPO2

 

 Treatment:

 

  • Supplemental Oxygen to maintain SPO2 > 92%
  • Align Airway Axes
  • Suction
  • Assess For/Remove Foreign Body Obstruction
  • OPA/NPA
  • Utilize One/Two-Person BVM

 

 Successful

 

  • Emergent Transport

 

 Unsuccessful

 

  • Consider BIAD

 

Successful

    • Emergent Transport

 

Unsuccessful

    • Consider ETT

 

Requires Post-Airway Sedation

 

  • Fentanyl 1 mcg/kg; Max 100 mcg
  • Midazolam 0.1 mg/kg; Max 5 mg

                                  OR

  • Ketamine 1 mg/kg; Max 200 mg

 

PEARLS:

 

  • Pediatric = 1 day to less than age 12, or less than 55 kg in ages 12-18.
  • Use Handtevy for drug dosages.
  • Pulse oximetry should be monitored continuously if initial saturation is less than or equal to 96%, or there is a decline in patient status despite normal pulse oximetry readings.
  • Do not force a child into a position. They will protect their airway by their body position.
  • The most important component of respiratory distress is airway control. Avoid direct laryngoscopy unless intubation is imminent.
  • BIAD is the preferred airway with patients in cardiac arrest. Deviation from this requires justification in PCR.
  • Capnometry or capnography is mandatory with all methods of advanced airway management with appropriate documentation.
  • An intubation attempt is defined as passing the laryngoscope blade or endotracheal tube past the teeth.
  • Ventilatory rate/minute should be 30 for neonates, 25 for toddlers, 20 for school age, and 8-24 for adolescents and adults. Maintain a EtCO2 between 35 and 45 and avoid hyperventilation.
  • Maintain C-spine immobilization for patients with suspected spinal injury.
  • Miller blade is preferred for pediatric patients.
  • Pad behind the patient's shoulders to achieve the sniffing position to assist in aligning airway axes.
  • Follow current BLS guidelines for foreign body airway obstruction. If ALS, consider direct laryngoscopy and magill forceps.