CME REVIEW ARTICLE
Alternative Airways for the Pediatric Emergency Department Jannet J. Lee-Jayaram, MD and Loren G. Yamamoto, MD, MPH, MBA
Abstract: Securing the pediatric airway in the emergency setting is an uncommon event that is complicated by anatomic, physiologic, and environmental factors. Even more uncommonly, practitioners are faced with the added complication of a difficult airway, and the question of what alternatives to traditional endotracheal intubation are available and most useful may arise. Timely and effective intervention determines the patient’s clinical outcome. The purpose of this review was to detail specific alternative airway management strategies and tools for use in the pediatric emergency department. Key Words: airway management, difficult airway, supraglottic device, laryngeal mask airway, perilaryngeal airway, esophageal-tracheal combination tube, laryngeal tube, lighted stylet, video laryngoscopy, needle cricothyrotomy, transtracheal ventilation (Pediatr Emer Care 2014;30: 191Y202)
TARGET AUDIENCE This CME article is intended for pediatric emergency medicine physicians, emergency medicine physicians, pediatricians, nurse practitioners, nurses, physician assistants, respiratory therapists, and any other medical personnel involved in the care of children presenting with respiratory distress or failure.
LEARNING OBJECTIVES After completion of this CME article, the reader should be able to: 1. Compare the various alternative options with traditional endotracheal intubation when securing the pediatric airway. 2. Plan the approach to specific situations where difficult airway management arises.
CASE A 4-year-old with Goldenhar syndrome is brought into the resuscitation bay of your emergency department (ED) by the triage nurse. The parents relay that the child has been ill with respiratory symptoms for the last few days but got worse in the last day. The child is lethargic, mottled, and working hard to breathe. On 100% oxygen nonrebreather mask, her pulse oximeter reads 82%, and heart rate for the moment is elevated, but she does not respond to noxious stimuli. You attempt to bagmask ventilate using the flow-inflating bag but are unable to obtain a seal with the mask around her nose and mouth. You attempt to use the self-inflating bag, but this does not produce adequate chest rise. What are the best options that you have available to you for securing the airway in an alternate fashion Assistant Professor of Pediatrics (Lee-Jayaram), Professor of Pediatrics (Yamamoto), Department of Pediatrics, University of Hawai’i John A Burns School of Medicine, Emergency Department, Kapi’olani Medical Center For Women & Children, Honolulu, HI. The authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interest in, any commercial organizations pertaining to this educational activity. Reprints Jannet J. Lee-Jayaram, MD, Department of Pediatrics, 1319 Punahou St, 7th Floor, Honolulu, HI 96826 (e
Alternative Airways for the Pediatric Emergency Department Jannet J. Lee-Jayaram, MD and Loren G. Yamamoto, MD, MPH, MBA
Abstract: Securing the pediatric airway in the emergency setting is an uncommon event that is complicated by anatomic, physiologic, and environmental factors. Even more uncommonly, practitioners are faced with the added complication of a difficult airway, and the question of what alternatives to traditional endotracheal intubation are available and most useful may arise. Timely and effective intervention determines the patient’s clinical outcome. The purpose of this review was to detail specific alternative airway management strategies and tools for use in the pediatric emergency department. Key Words: airway management, difficult airway, supraglottic device, laryngeal mask airway, perilaryngeal airway, esophageal-tracheal combination tube, laryngeal tube, lighted stylet, video laryngoscopy, needle cricothyrotomy, transtracheal ventilation (Pediatr Emer Care 2014;30: 191Y202)
TARGET AUDIENCE This CME article is intended for pediatric emergency medicine physicians, emergency medicine physicians, pediatricians, nurse practitioners, nurses, physician assistants, respiratory therapists, and any other medical personnel involved in the care of children presenting with respiratory distress or failure.
LEARNING OBJECTIVES After completion of this CME article, the reader should be able to: 1. Compare the various alternative options with traditional endotracheal intubation when securing the pediatric airway. 2. Plan the approach to specific situations where difficult airway management arises.
CASE A 4-year-old with Goldenhar syndrome is brought into the resuscitation bay of your emergency department (ED) by the triage nurse. The parents relay that the child has been ill with respiratory symptoms for the last few days but got worse in the last day. The child is lethargic, mottled, and working hard to breathe. On 100% oxygen nonrebreather mask, her pulse oximeter reads 82%, and heart rate for the moment is elevated, but she does not respond to noxious stimuli. You attempt to bagmask ventilate using the flow-inflating bag but are unable to obtain a seal with the mask around her nose and mouth. You attempt to use the self-inflating bag, but this does not produce adequate chest rise. What are the best options that you have available to you for securing the airway in an alternate fashion Assistant Professor of Pediatrics (Lee-Jayaram), Professor of Pediatrics (Yamamoto), Department of Pediatrics, University of Hawai’i John A Burns School of Medicine, Emergency Department, Kapi’olani Medical Center For Women & Children, Honolulu, HI. The authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interest in, any commercial organizations pertaining to this educational activity. Reprints Jannet J. Lee-Jayaram, MD, Department of Pediatrics, 1319 Punahou St, 7th Floor, Honolulu, HI 96826 (e
