A two year child presents with fever, stridor and a harsh cough.
His condition deteriorates and he requires intubation.Outline how you would do this.
Call for help
This should be in context-
a) if the child becomes hypoxic/has a respiratory arrest etc-proceed with attempt bag mask
ventilation 100% oxygen immediately - attempt intubation.
b) If there is time-aim to have the person with the best paediatric airway management expertise
Optimise medical management
a) High flow oxygen
b) if child hypoxic -can discuss avoiding distressing the child by holding mask away from face and
with child on parents lap (unless really sick)
c) IV steroids-adequate dose 00.6mglkg dexamethasone
d) NEB adrenaline 5mg (repeated doses)
e) Oxygen/Helium mixture if tolerates
Adequate discussion of preparationfor intubation
a) range of ETTs (size 4.0, 4.5. 5.0, 5.5)
b) two laryngoscopes with range of blade sizes-straight/curved
c) small diam "bougie"
d) cannula for percutaneous needle cricothyroidotomy + method for oxygen delivery
Intubation: One of 2 approaches
(1) Inhalational induction of anaesthesia with maintenance of spontaneous ventilation until adequate
depth of anaesthesia achieved to allow intubation (or to assess ability to ventilate-then proceed to
Or (2) IV induction-with paralysis
There must be some discussion regarding risks of either technique. Mere mention of IV approach will
not be enough to gain marks • There must be some discussion regarding risks of either technique
However, if not trained in inhalational anaesthetic techniques-reasonable to proceed with IV
induction of anaesthesia +muscle paralysis -with risk of being unable to ventilate
Alternate strategies if unable to intubate
Ventilate with LMA/face mask until help arrives
Rarely need to proceed to needle cricothyroidotomy
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Weathers E., "The Anatomy of the Pediatric Airway" 2010 -RC EDUCATIONAL CONSULTING SERVICES, INC.
Santillanes, Genevieve, and Marianne Gausche-Hill. "Pediatric airway management." Emergency medicine clinics of North America 26.4 (2008): 961-975.
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