1. Pediatric Airway Management
Brian Rogge
RN, EMT-P
Pediatric Flight Nurse NW MedStar

3. What is Airway Management?
Opening the airway
Clearing the airway
Securing the airway
After A comes B.

4. Why?
Most pediatric cardiac arrests are secondary to respiratory arrest or airway issue.

6. Open the airway Older Kids (greater than 5 years of age)
More Similar to adults
Head tilt chin lift
Think C-spine (Jaw thrust)
Younger Children
Cervical spine very flexible
Can push posterior pharynx toward tongue and occlude airway
“Sniffing position”

7. Open the airway
Towels are your friend!

8. Hey, what’s that sound

9. Everybody look what’s goin down

10. Is airway open? Are they now spontaneously breathing
Do you need to clear the airway?
Can you assist if they are not breathing
Chest Rise
Feel the bag
Again do you need to clear the airway?
This is a question you will need to ask over and over and over and over (how long is this transport?)

11. Clearing the airway NO BLIND FINGER SWEEPS! Suctioning the airway
Infant back blows and chest thrusts (5 each)
Pediatric heimlich on witness choking until unresponsive
Suctioning the airway
Not just for something to do
May cause harm
Trauma
Bradycardia

12. Clearing the airway Positioning Drainage
Semi-fowlers
Rescue position
Older children position of comfort
Remember other issues such as trauma

13. Securing the airway Check your protocols!!!!
Not every agency has intubation within their protocols
Can be very challenging due to frequency and pitfalls
Do you need to phone a friend?
Rendezvous with ALS or Air Service?
Medical Control (this is where closest appropriate facility may be challenging)

14. Securing the airway Know your equipment!!! Oral pharyngeal airways
Nasal Pharyngeal airway

15. Securing the airway More definitive airways Combitubes King Airways
Laryngeal Mask Airway (LMA)
Endotracheal tubes
Uncuffed
Cuffed

18. So finally done…..with A Move on to “B”reathing Rate Rhythm Quality
Sustainability and Trending
Reassessment

20. Rates Newborn 35-40 Infant (6 months) 30-50 Toddler (2 years) 25-32
Child
Adolescent
Adult

21. Breathing Is yours affective? Chest rise Color Improvement
If not, change what you need

22. Questions?
Brian Rogge

23. POST-TEST 1. You can occlude the airway in a pediatric patient by:
1. You can occlude the airway in a pediatric patient by:
A) Hyperextending the neck
B) Hyperflexing the neck
C) Both A & B are correct
D) None of the above
2. Pediatric tongue is relatively larger than the adult tongue
A) True
B) False
3. Wheezing and Stridor are signs of what respiratory problems:
A) Wheezing is from problems in the upper airway, stridor is from lower airway (lungs)
B) Wheezing and stridor are different names for the same thing
C) Wheezing is from problems in the lower airway (lungs), stridor is from upper airway
D) They are different, but treated the same way so it doesn’t matter
4.Pediatric cardiac arrest is usually caused from:
A) Primary cardiac arrest (sudden cardiac arrhythmia)
B) Primary respiratory problem (respiratory issue which leads to cardiac arrest)
5.There are many EMS agencies in which Pediatric intubation are not within their protocols:

24. A) Right behind the tongue
SECRET QUESTION
 The narrowest part of the pediatric airway is:
A) Right behind the tongue
B) Right above the vocal cords
C) At the vocal cords when they are open
D) At the cricoid cartilage

25. Stitchin’ Dreams Embroidery For providing our Secret Question prize
Special thanks to
Sheila Crow
Stitchin’ Dreams Embroidery
For providing our Secret Question prize

26. Questions? Contact: Samantha Roberts 509-242-4264 1-866-630-4033 robertss@inhs.org Fax: 509-232-8344

27. Updates Please
EMS presentation, all certificates will be printed by participants or their agency. The certificate template will be available through the health training website at the same location as all presentation downloads. It will be posted the day after each monthly presentation.