In this section
Ideally, facemasks should be clear to allow you to see:
A guide to sizes of Laerdel silicone face masks 00 and 0/1 - Neonate - infant 2 - infant - small children 3 - small - large children 4 - Adult 5 - Large adult:
Jaw thrust manoeuvre:
Oropharyngeal airway sizing:
Failure to obtain an airway by simple airway opening maneuvers (eg: OPA insertion)
Airway protection (eg: from blood, broken teeth, vomitus)
To provide a secure airway for transport
To control ventilation in the unconscious/head injured patient
Diameter Neonate - 3.0 mm 0-6 months -3.5mm 6-12 months -4.0 mm Then use (Age in years / 4) + 4 = size of endotracheal tube (ET) mm
Length of insertion at lips:
Visualise the tube passing through vocal cords avoiding endobronchial intubation:
Formula for length (at lips) of oral tube is Age/2 + 12
Curved or straight blades can be used although the straight blade laryngoscope is recommended in young children, because:
Have tubes of the appropriate size, plus tubes 0.5 mm ID smaller and 0.5 mm ID larger than that size, available on the child's bed.
Used whenever the stomach may not be
empty (i.e. in every injured child)
1. Pre-oxygenate the child:
2. Drugs: Always used unless the child is flaccid and unresponsive.
3. Intubate the trachea as soon as relaxed;
Avoid unnecessary bag and
mask ventilation prior to intubation as this may inflate the
stomach, increasing the risk of aspiration.
Laryngoscope: hold in your left hand. Be gentle.
< 1 year: Straight blade (Miller or Robertshaw).
> 1 year: Curved blade (MacIntosh 2 or 3):
4. Insert the endotracheal tube.
5.Insert an orogastric tube on free drainage.
Never use a nasogastric or nasotracheal tube in a child with a head injury (because of risk of meningitis, or of entry of cranial cavity in undiagnosed fracture of the skull base).
6. Check AP chest Xray: The ET tube tip should lie at the level of the medial end of the clavicles. If not, re-position the tube and re-tape.
7. Suction the ET tube carefully each hour - more often, if needed.
8. Humidify the inspired gases using a condenser humidifier (Swedish nose) between the ET tube and the self-inflating bag.
9. Splint the child's arms if necessary (child should be sedated)
If the airway is completely inadequate, consider:
Rationale for needle cyricothyroidotomy
Feel your own cricothyroid membrane: this is the horizontal gap between the thyroid cartilage (Adam's apple) above, and the horizontal cricoid cartilage below.