Protocol Status: PUBLISHED
Protocol:
Version: 2026.01
Effective Date:
Last Reviewed:
Medical Director Approval:
Clinical Note: This content reflects current GCEMS clinical guidelines as of the dates listed above. If content appears inconsistent with current policy, use the most recent approved guideline and notify leadership for correction.

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.