Ultimate ATLS 10: ABC's of Pediatric Trauma - Airway Management, Anatomy & Needle Cricothyrotomy

Summary

This video provides an in-depth guide to pediatric airway management, highlighting key anatomical challenges and essential techniques. It discusses how children’s larger heads, smaller mouths, and narrower airways complicate intubation and ventilation. Emphasis is placed on the importance of airway and spinal protection, especially when managing trauma patients. The script also outlines best practices for securing the airway in children, including specific considerations for intubation, ventilation, and emergency procedures like needle cricothyrotomy. The use of pediatric resuscitation tapes, equipment checks, and monitoring tools is also emphasized to ensure effective care in critical situations.

Takeaways

• 😀 Airway management in pediatric patients is complex due to anatomical differences, particularly in children under three years old.
• 😀 Children under eight years old have relatively large heads, increasing the risk of head trauma, hypoxia, and apnea, making airway and breathing management critical.
• 😀 When positioning a child for airway maintenance, ensure proper padding to avoid airway obstruction caused by the head flexing in the supine position.
• 😀 Young children are at an increased risk of spinal cord injuries without radiographic abnormalities, so assume a c-spine injury until proven otherwise.
• 😀 Kids have smaller mouths, larger tongues, and a floppy epiglottis, all of which make airway obstruction more likely, especially if they're semi-conscious or comatose.
• 😀 The larynx and vocal cords in children are more anterior and superior, making visualization more challenging during intubation.
• 😀 The trachea in children is narrow and short, with maximal narrowing at the cricoid ring, making procedures like cricothyroidotomy more difficult.
• 😀 Surgical cricothyroidotomy is not recommended for children under 12; instead, perform a needle cricothyroidotomy if intubation or other airway management techniques fail.
• 😀 It is important to be prepared for needle cricothyroidotomy by ensuring you have the correct equipment, such as a special connector kit for O2 or using a three-way stopcock.
• 😀 When intubating pediatric patients, avoid the common 180-degree twist seen in adults when placing an oral airway. Instead, use a tongue depressor to guide the airway into position.
• 😀 Using a pediatric resuscitation tape is essential for quickly accessing tube sizes, drug doses, and other crucial information during pediatric resuscitation.

Q & A

Why is airway management challenging in children, especially those under three years old?

Airway management in children, particularly those under three years old, is challenging due to anatomical factors such as their large heads, small airways, and flexible spines. These factors can lead to increased risks of hypoxia, apnea, and difficulties in intubation and airway maintenance.

What are the three main reasons why a child's large head complicates airway management?

1) Head trauma is common in children with blunt trauma, increasing the risk of hypoxia and apnea. 2) A large head in the supine position without proper padding causes airway obstruction due to neck flexion. 3) The large head position aggravates any cervical spine injuries and increases the risk of spinal cord injury without radiographic abnormality.

What is the impact of a child's anatomy on airway management when they are in a supine position?

In a supine position, a child's large head causes the neck to flex, which can obstruct the airway. Additionally, this position may exacerbate any cervical spine injuries due to inappropriate neck flexion.

Why are children at a higher risk of spinal cord injuries without radiographic abnormalities?

Children, especially younger ones, have more flexible spines, which increases the risk of spinal cord injuries even if there are no visible abnormalities in radiographic imaging.

What anatomical features of a child’s airway predispose them to obstruction in the supine position?

Children have small mouths, large tongues, prominent tonsils, and a floppy U-shaped epiglottis. These features make them more prone to airway obstruction, especially when they are semi-conscious or comatose.

Why is it difficult to visualize the airway during intubation in children?

The larynx and vocal cords in children are more anterior and superior compared to adults, making visualization during intubation more challenging.

What makes performing a cricothyroidotomy difficult in young children?

The cricothyroid membrane in young children is difficult to palpate, and their trachea is both narrow and short. These anatomical factors make performing a cricothyroidotomy difficult, especially in infants and small children.

When should a needle cricothyroidotomy be performed in children?

A needle cricothyroidotomy should be performed if a child is under 12 years old and intubation or other airway management techniques have failed. A surgical cricothyroidotomy is not performed on children under 12.

What are the key considerations when performing a needle cricothyroidotomy on a child?

When performing a needle cricothyroidotomy on a child, it is essential to ensure the oxygen is connected to the needle catheter properly. Some emergency departments may have special connector kits, but if unavailable, a three-way stopcock or direct connection to oxygen tubing can be used.

How can you prevent right main stem bronchus intubation in children?

To prevent right main stem bronchus intubation, check and recheck the placement of the tube. Due to the short trachea in children, there is a higher risk of tube dislodgement, especially during patient transfer.

Why is it important to use a pediatric resuscitation tape during airway management in children?

A pediatric resuscitation tape is vital because it provides quick access to critical information such as appropriate tube sizes, drug dosages, and other vital resuscitation details. It ensures proper and efficient airway management.

What should you do to secure an intubation tube in a child?

Once the intubation tube is properly placed, secure it at the level of the gums. The tube size should correspond to the number that is three times the ET tube size. Confirm placement with auscultation, end-tidal CO2 monitoring, and a check for main stem bronchus intubation.