Chapter 19 Flashcards
How would you assess the airway of a child?
Look, listen and feel for airway obstruction, respiratory depression/arrest/distress
If tubed check for correct plavement and functioning
Assess the effort of breathing
Auscultate for breath sounds
Assess skin colour
How would you treat an airway problem?
Perform basic airway opening manouvres Give high flow oxygen Provide suction if necessary Place an adjunct Proceed to advanced airway management if needed
How would you manage breathing in the presence of an airway problem?
Establish ventillation via a bag valve mask
Decompress the stomach with a large bore NG or OGT it necessary
How is an oropharyngeal airway sized?
Measure from centre of incisors to angle of the mandible
How is a nasopharyngeal airway sized?
Measure length from materal edge of nostril to tragus
An appropriate diametre should fit comfortably in the nostril without causing blanching
Shortened ET tubes can be used with a large safety pin attached if a suitsble size is not available
How are LMAs sized?
By weight <5kg —> 1 with 5mL in cuff 5-10 —> 1.5 with 7mL in cuff 10-20 —> 2 with 10mL in cuff 20–30 —> 2.5 with 15mL in cuff 30-50 —> 3 with 20mL in cuff 50-70 —> 4 with 30mL in cuff >70 —> 5 with 40mL in cuff
How are igels sized?
By weight <5 —> 1 5-12kg —> 1.5 10-25 —> 2 25-35 —> 2.5 30-60 —> 3 50-90 —> 4
What is the timescale for performing intubation?
30 seconds
How are ET tubes sized?
(Age/4) + 4
For neonates most require uncuffed 3 or 3.5
For age 6 months size 4 is used
For age 1 year 4.5 is used
How is ET tube length estimated?
(Age/2) + 12 for an oral tube
(Age/2) + 15 for a nasal tube
What considerations need to be given when choosing between a cuffed or uncuffed ET tube for an infant?
An uncuffed tube reduces the risk of pressure related damage to the mucosa and post extubation swelling. However inherently leads to air leak and can make it difficult to achieve adequate ventillation.
A cuffed tube removes air leak but can lead to mucosal damage therefore cuff pressures should be closely managed.
What basic monitoring should be performed in an intubated patient?
Oxygen saturation monitoring
Capnometry
Auscultation post insertion in axillae and over stomach
Check for bilateral chest expansion
Name four potential problems that can occur with an ET tube. (hint DOPE)
D- Displaced (endobronchial or oesophageal)
O- Obstructed (blocked or kinked)
P- Pneumothorax
E- Equipment problems (may include ventilator, leaks, disconnection, gas supply issues)
What are the steps to managing a blocked tracheostomy?
Stimulate the child
Shout for help
Open and assess the airway
Apply oxygen to face and tracheostomy
Assess patency of the tracheostomy using a suction catheter
If you cannot pass a suction catheter change the tube
If this fails or you cannot insert one use a half size smaller or pass it over a suction catheter
If this is unsuccesful remove the tube and check for breathing
If not breathing administer rescue breaths via the upper airway if you can open it or via the tracheostomy
