RCH Melbourne TRauma - airway managementĬhris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne.RCH Melbourne Trauma - airway procedures.RCH Melbourne CPG - emergency airway management.Controversies in rapid sequence intubation in children. Zelicof-Paul A, Smith-Lockridge A, Schnadower D, Tyler S, Levin S, Roskind C, Dayan P.Rapid sequence intubation for pediatric emergency patients: higher frequency of failed attempts and adverse effects found by video review. Kerrey BT, Rinderknecht AS, Geis GL, Nigrovic LE, Mittiga MR. Pediatric rapid sequence intubation: incidence of reflex bradycardia and effects of pretreatment with atropine. Rapid sequence induction has no use in pediatric anesthesia. Pediatric rapid sequence intubation: a review. if a nasogastric tube is in situ leave in place during the procedure as will help decompress stomach if bag-mask ventilation required, remove post procedure if indicated.once endotracheal tube is satisfactory position cricoid pressure can be released.traditionally uncuffed until age 8, then cuffed (a ‘one-size smaller’ cuffed tube can be used in children 2 years old then endotracheal tube should be at lips by formula age/2 + 12cm.Once patient fasciculated/ paralysed perform rapid laryngoscopy with placement of a endotracheal tube.Suxamethonium 1-2mg/kg IV (2mg/kg for neonates, and 1mg/kg children) OR rocuronium 1.2mg/kg IV.Cricoid pressure applied by skilled assistance (optional).choice of induction age and dose may be modified according to clinical context (e.g.Induction with thiopentone 3-6mg/kg IV as long as patients haemodynamics will tolerate this dose.this may be difficult with an uncooperative child, a cautious dose of fentanyl 0.25mcg/kg IV provides a slightly sedated more compliant child, however caution needs to be taken as airway protection must be maintained, not normally a problem for small children, but older ones may kick up a fuss.4 vital capacity breaths or until ETO2 is concentration >90%.follow this link for differences in the paediatric airway.Note that pretreatment with atropine, while traditionally given prior to intubation in children, is generally not necessary.the basic approach is similar to that in adults.RSI is used to secure the airway quickly with an endotracheal tube and to prevent chance of regurgitation and aspiration.
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