Pediatric Emergency Medicine

Front 1

ANATOMIC DIFFERENCE IN AIRWAY

Back 1

1. Larger head-to-body ratio may cause a slight flexion when the child is immobilized on the spine board. A small towel roll placed under the child’s shoulders may enhance the “sniffing” position.
2. Small oral cavity, with relatively larger tongue, may make orotracheal intubation more difficult.
3. Larger mass of adenoidal tissue may make nasotracheal intubation difficult. For this reason, orotracheal intubation is preferred.
4. Epiglottis is more “U” shaped, larger, and “floppier.”
5. Larynx is more cephalad and anterior.
6. Vocal cords are shorter, cartilaginous, and more distensible, which increases risk of injury during laryngoscopy.
7. Cricoid ring is the narrowest point of the airway. Noncuffed endotracheal tubes are recommended in children less than 8 years old, to avoid trauma to subglottic region.
8. Shorter tracheal length makes intubation of main stem bronchus and accidental extubation more common.
9. Narrow tracheal diameter and smaller spaces between rings make emergency tracheostomy very difficult. It should not be attempted except by trauma surgeon in controlled setting.