Respiratory Problems

are the most common cause of

Pediatric ArrestWanida PaoinThammasat

Hospital,Thammasat University

๐Airway๐ positioning, opening๐ oro/nasopharyngeal airway

๐Breathing๐ mouth to mouth (+ nose) ๐ bag-mask๐ laryngeal mask๐ endotracheal intubation

Airway Anatomy & Physiology

Large tongueHigh glottis

Slanting vocal cord

Narrow cricoid ring

C4

C7

Narrower nares

Large occiputImmature laryngeal reflex

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Airway Anatomy & Physiology

Loose tissue

Airway Anatomy & Physiology

• Position• Open the airway

– - head tilt chin lift maneuver– - jaw thrust maneuver– oropharyngeal and nasopharyngeal airway– - foreign body airway obstruction

Airway

head tilt-chin lift jaw-thrust

Oropharyngeal Airway

Nasopharyngeal Airway

Indication

Breathing•Assessment• Provide rescue breathing

–mouth-to-mouth-and-nose and mouth-to mouth– - bag mask ventilation– laryngeal mask airway– endotracheal intubation– ventilation through a tracheostomy or stoma

self inflatingsize > 450-500 ml.

“E-C clamp

gastric inflation cricoid pressure

visible chest risingavoid excessive ventilation

reservoirO 2 flow > - 10 15 L/min

O2

-conc. 60 95%opening the airway

appropriately sized mask

B - ag mask ventilation

• used in unconscious patient• contraindicted in a patient w

ith an intact gag reflex• eqivalent ventilation compar

e with ET tube• uncommom aspiration• more difficult to maintain th

an ET tube

Laryngeal Mask Airway

Laryngeal Mask Airway

•Advantages• Indications•Equipment•Procedure•Verification of proper

tube placement

Endotracheal Intubation

3 tracheal tube: cuff or uncuffsuction catheteroxygen sourceface maskself-inflating bag + PEEP valvestyletlubricantlaryngoscope blade and handleexhaled CO2 detectortape and equipment to immobilize

uncuffed tube: tracheal tube size (mm) = age in years + 4 4

cuffed tube: tracheal tube size (mm) = age in years + 3

4

Endotracheal tube size

•Advantages• Indications•Equipment•Procedure•Verification of proper

tube placement

Endotracheal Intubation

Displacemant

Deteriorating condition of an intubated patient

EquipmentfailurePneumothorax

Obstruction

๐Airway๐ positioning, opening๐ oro/nasopharyngeal airway

๐Breathing๐ mouth to mouth (+ nose) ๐ bag-mask๐ laryngeal mask๐ endotracheal intubation