1. Pediatric Airway Management Dr. Shapiro I., PICU Dec 2003

2. Adult Chain of Survival Early Defibrillation CPR ALS EMS

3. Pediatric Chain of Survival Prevention ALS CPR EMS

6. Pediatric Cardiorespiratory Arrests 10% 10% 80%

7. Pediatric Cardiorespiratory Arrests Hypoxia and Hypercarbia Bradycardia RESPIRATORY ARREST CARDIOPULMONARY ARREST

8. 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% Outcome of cardiac arrest in children

9. Survival from Respiratory Arrest Respiratory Arrest Alone – more than 50% neurologically intact survival rate

10. Pediatric Chain of Survival Prevention ALS CPR EMS

11. To Simplify the Message… Early Defibrillation 8 years Age With exceptions… (submersion, trauma, drug overdose) With exceptions… (sudden collapse, cardiac history)

12. PREVENTION 1992 SIDS SIDS More Than 50%... "BACK TO SLEEP"

13. Respiratory Distress Respiratory Failure and Respiratory Arrest BLS

16. Upper Airway Obstruction turbulence

17. Lower Airway Obstruction turbulence & wheezing

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

19. Anatomy : Airway Nose Tongue Epiglottis Vocal Cords Larynx

22. Effect Of Edema Poiseuille’s law

23. Basic Life Support A+B

25. Airway Head Tilt-Chin Lift Jaw Thrust + Tongue-Jaw Lift Maneuver (FBAO)

30. Oropharyngeal Airway SIZE PROPER POSITION

31. Nasopharyngeal Airway

32. Nasopharyngeal Airway

33. Bag-Mask Ventilation Proper area for mask application

34. Bag-Mask Ventilation Sellick Maneuver

35. Laryngeal Mask Contraindicated if gag-reflex is intact Higher success rate Does NOT protect from aspiration Difficult to maintain during transport

36. Intubation

38. Tracheal Tube Children > 2 years: ETT size: (Age+16)/4 ETT depth (lip): ETTsize x 3 Age kg ETT Length 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

39. Laryngoscope Blades Better in younger children with a floppy epiglottis Straight

40. Laryngoscope Blades Better in older children who have a stiff epiglottis Curved

41. Intubation Technique