App aw adj&bvm

Pediatrics

Pediatric Airway Management

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Objectives

•By the end of this PowerPoint the learner will be able to:

‐Restate at least…

•5 complications associated with the use of airway adjuncts

•3 complications associated with bag-valve-mask ventilation (BVM) ventilation

‐Choose an appropriately sized airway adjunct and BMV facemask according to anatomic landmarks

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xxx00.#####.ppt 11/14/13 09:29 PMPediatrics

Positioning (“sniffing”)

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Positioning - Infant

R

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Positioning - Comparison

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Obstruction

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Options – Chin lift

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Options – Jaw Thrust

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Options - Oral Airway

•Prevents upper airway obstruction

•May make Bag-valve-mask ventilation more effective

•Should not be used in semi comatose of alert patients

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Options – Oral Airway

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Oral Airway

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Oral Airway – Too Small

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Oral Airway – Too Large

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Insertion Technique

•First open mouth (can use cross finger scissor technique)

•Option # 1 – push tongue down w/ tongue depressor and insert “straight in”

•Option # 2 – insert “upside down” and then rotate 180 degrees as oral airway is being advanced to back of oropharynx

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Oral Airway Complications

•Yak*$%! (ie the gag reflex)

•Aspiration

•Obstruction (not really your desired effect)

•Laryngospasm

•Tooth/mouth injury

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Nasopharyngeal Airways

•Same concept of relieving tongue obstruction

•Better tolerated than oral airway if patient semi-conscious or awake

•Contraindicated with:‐Significant facial trauma (esp basilar skull fracture)

‐Severe coagulopathy

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Nasopharyngeal Airways Complications

•Laryngospasm and coughing (esp if too long)

•Nosebleeds

•Sinus infection

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Size Selection

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Nasopharyngeal Airway Insertion

•Don’t forget the lube!

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Bag Mask Ventilation

•True life saving technique

•Can oxygenate and ventilate

•Helpful during intubation‐Can “improve” patient so that intubation is less strenuous

‐Can “rescue” patient if intubation attempt fails

•May need airway adjunct and two people!!!

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Equipment

•Self inflating reservoir bag, unidirectional valve, standard mask connector, oxygen hook-up

‐Manometer, PEEP valve

•Different size masks

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Mask Size and Fit

•Extend from bridge of nose to chin (covering mouth and nose)

•Inflatable rim can help assure seal

•“E-C” hold is preferred technique‐Thumb and forefinger form C on top of mask

‐Middle/ring fingers on ridge of mandible (chin lift)

‐Pinky behind angle of mandible (jaw thrust)

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E-C Hold

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Successful BMV

•Chest rise

•Chest rise

•Chest rise

•Increased O2 sats, auscultation, condensation in mask

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Complications of BMV

•Excessive air in stomach‐Aspiration risk

‐Decreases lung volume/requires higher PIPs

•Corneal abrasions

•Injury to lips/gums and nasal bridge

•Excessive bagging due to user exuberance

Pediatrics

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App aw adj&bvm