1. Pediatric Airway Management Margaret Winkler, MD Pediatric Critical Care University of Alabama at Birmingham

4. Pediatric Cardiopulmonary Arrests 10% 10% 80%

5. Age distribution of arrests <7 mos 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 7-12 mos Age (years) # Arrests

6. Schindler M, et al. Outcome of out-of-hospital cardiac or respiratory arrest in children. N Engl J Med 1996;335:1473-1479. Arrive in ER in cardiac arrest (N = 80) Admit PICU (N=43) 54 % Died in ER (N=37) 46% Mod Deficit (N=3) PVS at 12 mos (N=2) Dead at 12 mos (N=1) Died in ICU (N=37) 46%

7. Anatomy Children are very different than adults !!!

11. Children are different

15. Physiology: Effect of Edema Poiseuille’s law If radius is halved , resistance increases 16fold R = 8 n l  r 4

17. Airway positioning for children <2yrs

19. Airway Positioning “ Sniffing Position” In the child older than 2 years Towel is placed under the head

23. Endotracheal tube as nasal airway A regular ETT can be cut and used as a nasal airway

24. Adjuncts: Oral Airway Wrong size: Too Long

25. Adjuncts: Oral Airway Wrong size: Too Short

26. Adjuncts: Oral Airway Correct size

27. Oral Airways

37. Cephalad and anterior

38. Laryngoscope Blades Macintosh Miller

39. Intubation Technique Straight Laryngoscope Blade – used to pick up the epiglottis Better in younger children with a floppy epiglottis

40. Intubation Technique Curved Laryngoscope Blade – placed in the vallecula Better in older children who have a stiff epiglottis

41. Intubation Age kg ETT Length (lip) Newborn 3.5 3.5 9 3 mos 6.0 3.5 10 1 yr 10 4.0 11 2 yrs 12 4.5 12 Children > 2 years: ETT size: Age/4 + 4 ETT depth (lip): Age/2 + 12

42. Technique: Intubation How far does it go in ?