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
Unsuccessful
Successful
Unsuccessful
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.