Tintinelli Peds Airway

Front 1

Up until what age is the pediatric airway different?

Back 1

8 years

Front 2

In what ways is the pediatric airway different?

Back 2

Large occiput
Large tongue
Larynx is higher in the neck (C3 in the child and C4-C5 in the adult)
Narrowest in the subglottic area (rather than at the vocal cords)
vocal cords are slanted anteriorly

Front 3

What are congenital causes of abnormal airways?

Back 3

Choanal atresia
Cystic hygroma
tracheoesophageal fistula
trisomy 21 (short neck, small mouth, large tongue)

Front 4

What are visual signs of possible airway compromise

Back 4

Tachypnea
cyanosis
drooling
nasal flaring
intercostal retractions

Front 5

How do you size an OPA?

Back 5

Corner of the mouth to the angle of the mandible

Front 6

When should you not use an OPA?

Back 6

In a conscious child

Front 7

How do you size an NPA?

Back 7

Tip of the nose to the tragus of the ear

Front 8

What are complications of NPA?

Back 8

Damage to the adenoid tissue
epistaxis
laryngospasm

Front 9

At what oxygen flow do you get max O2 delivery?

Back 9

15L/min

Front 10

When is a straight laryngoscope blade superior?

Back 10

In children younger than 2

Front 11

What are the ETT sizes for neonates?

Back 11

<1.5kg 2.5mm
1.5-2.5kg 3.0mm
2.5-3.5kg 3.5mm

Front 12

What is the formula for determining ETT size in kids?

Back 12

4 + (age/4)
Should use resus measuring tapes

Front 13

What is the difference in pre-oxygenation of kids?

Back 13

Due to their relatively high oxygen consumption they undergo faster desaturation

Front 14

How can you accomplish effective de-nitrogenation?

Back 14

2mins of passive oxygenation or 4 vital capacity breaths

Front 15

What is the role of atropine in pediatric intubation?

Back 15

Atropine 0.015-0.2mg/kg IV push (it is given to prevent bradycardia associated with posterior pharyngeal stimulation)

Front 16

What are the postives and negatives of thiopental?

Back 16

It may cause myocardial suppression and ventilation resulting in decreased BP and increased HR

It decreases IOP and ICP

Front 17

When should cricothyrotomy be avoided in pediatrics?

Back 17

In those under 10 years of age

Front 18

How do you perform a needle cricothyrotomy?

Back 18

14g needle
through the cricothyroid membrane at a 45 degree angle caudad
attach adapter (from a 3.0ETT)
requires 50psi (attache high pressure O2 tubing directly to oxygen port) but this can only be done in children >5years of age
o/w use a BVM.
Given 1s jet followed by 4s expiration

Front 19

Discuss the duration of RSI in kids?

Back 19

Children have a larger ECF compartment therefore quicker onset and shorter duration of action of the drugs

Front 20

When do the anatomical differences in pediatric airways make the biggest difference?

Back 20

In the 1st few years of life. From 2-8years there is a transition from smaller (but similarly proportional anatomy)

Front 21

How do you deal with the large head and occiput?

Back 21

A Shoulder roll may be required to align airway axes

Front 22

How do you deal with a large tongue?

Back 22

Jaw thrust
OPA/NPA
Miller

Front 23

How do you deal with a more superior larynx and anterior cords?

Back 23

Shoulder roll
Straight blade

Front 24

How do you deal with cricoid narrowing?

Back 24

Monitor cuff insufflation in small children

Front 25

How do you deal with large adenoids?

Back 25

Avoid blind nasal intubation in young children

Front 26

How do you deal with small cricoid cartilage?

Back 26

Needle cricothyrotomy in the young

Front 27

How do you deal with large stomach and low LES tone?

Back 27

Consider early OG or NG

Front 28

Can cuffed ETT be used in children?

Back 28

Yes, but cuff inflation pressures must be monitored

Front 29

Discuss the pop-off valve?

Back 29

Most pediatric BVMs incorporate a pop-off valve to avoid barotrauma. In some diseases you may require higher peak pressures and therefore need to disable it

Front 30

How can you estimate the depth of insertion of an ETT in a child?

Back 30

tube size x 3

Front 31

What are contraindications/complications of succinylcholine?

Back 31

Hyperkalemia
Burns >5d old
Crush >5d old
severe infection >5d old
neuromuscular disease
Masseter spasm
Increased intragastric and intraocular pressure - possible increase in ICP
malignant hyperthermia
bradycardia
prolonged apnea in pseudocholinesterase deficiency
fasciculations

Front 32

Is atropine use in RSI of kids recommended?

Back 32

No, give it if symptomatic bradycardia occurs

Front 33

What are reasonable initial vent settings in <10kg?

Back 33

RR20-25 breaths/min
PIP 15-20 cmH20 (usually achieves 8-12c/kg)
1:2 I:E ratio
+/- PEEP 3-5

Front 34

What is the management of FB obstruction?

Back 34

If conscious -> Heimlich in >1 year old and back blows/chest thrusts in <1year old

If unconscious-> direct laryngoscopy, try and remove with MaGill forceps or intubated and push object into bronchus

Front 35

What is the best approach to micrognathia?

Back 35

BVM +/- LMA

Front 36

Can the intubating LMA be used in kids?

Back 36

Only >30kg

Front 37

Can the combitube be used in kids?

Back 37

only >48 inches

Front 38

Can the king LT be used in peds?

Back 38

Promising

Front 39

How do you achieve the sniffing position in an infant or child?

Back 39

PALs says to use a towel under the torso of those <2 years. Landmark by positioning the opening of the external auditory canal aligned with the anterior aspect of the shoulder when the neck is extension.

Front 40

What are the doses of midazolam, ketamine, proposal, succinylcholine and rocuronium in peds resus?

Back 40

Midazolam 0.3mg/kg
Ketamine 2-4 mg/kg
Propofol 2-3 mg/kg
Succinylcholine 2mg/kg
rocuronium 1mg/kg

Front 41

What oxygen concentrations do the following systems provide nasal cannula, simple face mask, partial rebreather, nonrebreathing mask, osygen hood, venturi mask, face tent, oxygen tent?

Back 41

nasal cannula - varies with resp rate, effort and size

face mask - 30-50% (must use 6L/min)

partial rebreather mask - 50-60% (use 10-12 L/min)

nonrebreathing mask with reservoir (simple face mask + reservoir + 2 valves) 95% (wiht 10-15 L/min

Oxygen hood 40-60%

Venturi mask 25-60%

Face tent 40%

Oxygen tent 30%

Front 42

When should you use a cuffed vs uncured?

Back 42

Cuffed is as safe as the uncuffed beyond the newborn period. A cuffed tube is preferred in certain circumstances: poor lung compliance, high airway resistance, large glottis leak

Front 43

What should the cuff inflation pressure be?

Back 43

20cmH20

Front 44

How do you determine the pediatric cuffed ETT?

Back 44

3.5 (or 3) + (age in years/4)

Front 45

What suction force should be used for suctioning of the airway via ETT?

Back 45

80-120 mmHg

Front 46

When can ETCO2 be low despite adequate ETT placement?

Back 46

-in cardiac arrest because of low pulmonary blood flow
-contaminated detector with gastric content or endotracheal epinephrine
-post IV bolus epinephrine (reduction in pulmonary blood flow)
-severe airway obstruction (status asthmaticus)
-pulmonary edema

Front 47

Why are IV and IO routes preferred over the ETT route?

Back 47

IV or IO will provide more predictable drug delivery and pharmacologic effect