Neonatal intubation - Revision history

Rossdonaldson1: Redirected page to Intubation (peds)

2020-05-18T18:08:41Z

← Revisión anterior		Revisión del 18:08 18 may 2020
Línea 1:		Línea 1:
	~~==General considerations==~~		#REDIRECT[[Intubation (peds)]]
	*Anatomical differences of neonates (compared to adults/big kids):
	**Large occiput--> may need shoulder roll to get ear to sternal notch aligned
	**Relatively larger tongue, small mouth
	**More anterior larynx
	**Larger/floppier epiglottis
	**Short trachea--> easy to mainstem tube, easy for accidental tube dislodgement

	*Cuffed vs uncuffed ETT: controversial<ref>https://pedemmorsels.com/cuffed-endotracheal-tubes-in-children/</ref> but cuffed tubes now genearlly considered acceptable<ref>American Heart Association. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, Vol. 122, Issue 18, Suppl 3; Novemeber 2, 2010.</ref>

	# ~~Numbered list item~~
	~~==Endotracheal~~ Intubation==
	~~{\| {{table}}~~
	~~\| align="center" style="background:#f0f0f0;"\|'''Age'''~~
	~~\| align="center" style="background:#f0f0f0;"\|'''Weight (kg)'''~~
	~~\| align="center" style="background:#f0f0f0;"\|'''Cuffless'''~~
	~~\| align="center" style="background:#f0f0f0;"\|'''Cuffed'''~~
	~~\| align="center" style="background:#f0f0f0;"\|'''Depth~~ (cm)~~'''~~
	~~\| align="center" style="background:#f0f0f0;"\|'''Blade'''~~
	\|-
	~~\| Preterm\|\|<1\|\|2.5\|\|-\|\|6-7\|\|Miller 00 or 0~~
	\|-
	~~\| Preterm\|\|1-2.5\|\|3.0\|\|-\|\|7-9\|\|Miller 0~~
	\|-
	~~\| Neonate\|\|2.5-4\|\|3.0\|\|-\|\|10\|\|Miller 0~~
	\|}

	*ETT depth
	**Newborn/neonate: uncuffed ETT x 3 (cm at lip)
	**Preemie: weight in kg +1 (cm at lip)
	*LMA size
	**Weight in kg/20 + 1
	*Apneic O2 by NC for newborn/neonate: 5L/m
	*Routine vent settings
	**FiO2 100%--> wean
	**PEEP 4-5
	**TV 8-10cc/kg
	**RR 25-35
	**I-time 0.5s

	~~==Drugs==~~
	*[[Atropine]] premedication
	**Controversial
	**Neonates VERY prone to [[PALS: Bradycardia\|bradycardia]] with myriad stimuli, including the vagal stimulation of laryngoscopy
	**May not be needed routinely but should at least have handy in case of bradycardia<ref>https://pedemmorsels.com/atropine-needed-rsi/</ref>
	**0.01-0.03 mg/kg IV/IO

	*Sedation
	**[[Ketamine]] ''not'' approved for <3mo <ref>https://reference.medscape.com/drug/ketalar-ketamine-343099</ref>
	**[[Fentanyl]] 1mcg/kg
	**[[Etomidate]] 0.3mg/kg
	*[[Neuromuscular blocking agents\|Paralytic]]- consider double dose in shock
	**[[Rocuronium]] 1.2mg/kg
	***Preferred as may not yet be aware of preexisting conditions that would make sux contraindicated
	**[[Succinylcholine]] 1.5mg/kg

	~~==See Also==~~
	*[[Neonatal resuscitation]], [[newborn resuscitation]]
	*[[Pediatric jet ventilation]]
	*[[The difficult airway]]

	~~==External Links==~~


	~~==References==~~
	~~<references/>~~

	~~[[Category:Procedures]]~~
	~~[[Category:Pediatrics]]~~
	~~[[Category:Critical Care~~]]

Cdichang: /* Endotracheal Intubation */

2020-05-17T02:27:05Z

Endotracheal Intubation

← Revisión anterior		Revisión del 02:27 17 may 2020
Línea 11:		Línea 11:
	# Numbered list item		# Numbered list item
	==Endotracheal Intubation==		==Endotracheal Intubation==
	{\| ~~class~~="~~Neonatal Endotracheal Intubation~~"		{\| {{table}}
			\| align="center" style="background:#f0f0f0;"\|'''Age'''
			\| align="center" style="background:#f0f0f0;"\|'''Weight (kg)'''
			\| align="center" style="background:#f0f0f0;"\|'''Cuffless'''
			\| align="center" style="background:#f0f0f0;"\|'''Cuffed'''
			\| align="center" style="background:#f0f0f0;"\|'''Depth (cm)'''
			\| align="center" style="background:#f0f0f0;"\|'''Blade'''
	\|-		\|-
	~~! Age !! Weight(kg) !! Cuffless !! Cuffed !! Depth(cm) !! Blade~~		\| Preterm\|\|<1\|\|2.5\|\|-\|\|6-7\|\|Miller 00 or 0
	\|-		\|-
	~~\| Preterm \|\| <1kg \|\| 2.5 \|\| - \|\| 6-7 \|\| Miller 00 or 0~~		\| Preterm\|\|1-2.5\|\|3.0\|\|-\|\|7-9\|\|Miller 0
	\|-
	\| Preterm \|\| 1-2.5 \|\| 3.0 \|\| - \|\| 7-9 ~~\|\| Miller 0~~
	\|-
	~~\| Neonate \|\| 2.5-4 \|\| 3.0 \|\| - \|\| 10~~ \|\| Miller 0
	\|-		\|-
			\| Neonate\|\|2.5-4\|\|3.0\|\|-\|\|10\|\|Miller 0
			\|}

	*ETT depth		*ETT depth

Cdichang: /* Endotracheal Intubation */

2020-05-17T02:20:49Z

Endotracheal Intubation

← Revisión anterior		Revisión del 02:20 17 may 2020
Línea 9:		Línea 9:
	*Cuffed vs uncuffed ETT: controversial<ref>https://pedemmorsels.com/cuffed-endotracheal-tubes-in-children/</ref> but cuffed tubes now genearlly considered acceptable<ref>American Heart Association. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, Vol. 122, Issue 18, Suppl 3; Novemeber 2, 2010.</ref>		*Cuffed vs uncuffed ETT: controversial<ref>https://pedemmorsels.com/cuffed-endotracheal-tubes-in-children/</ref> but cuffed tubes now genearlly considered acceptable<ref>American Heart Association. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, Vol. 122, Issue 18, Suppl 3; Novemeber 2, 2010.</ref>

			# Numbered list item
	==Endotracheal Intubation==		==Endotracheal Intubation==
	{\| class="~~wikitable~~"		{\| class="Neonatal Endotracheal Intubation"
	\|-		\|-
	! Age !! Weight(kg) !! Cuffless !! Cuffed !! Depth(cm) !! Blade		! Age !! Weight(kg) !! Cuffless !! Cuffed !! Depth(cm) !! Blade

Cdichang: /* Endotracheal Intubation */

2020-05-17T02:19:45Z

Endotracheal Intubation

@@ Línea 14: / Línea 14: @@
 ! Age !! Weight(kg) !! Cuffless !! Cuffed !! Depth(cm) !! Blade
 |-
-| Preterm || <1kg || 2.5 || - || 6-7 || Miller 0
+| Preterm || <1kg || 2.5 || - || 6-7 || Miller 00 or 0
 |-
 | Preterm || 1-2.5 || 3.0 || - || 7-9 || Miller 0
@@ Línea 20: / Línea 20: @@
 | Neonate || 2.5-4 || 3.0 || - || 10 || Miller 0
 |-
 *ETT depth
 **Newborn/neonate: uncuffed ETT x 3 (cm at lip)

Cdichang: /* Equipment/sizes/numbers */

2020-05-17T02:14:27Z

Equipment/sizes/numbers

@@ Línea 9: / Línea 9: @@
 *Cuffed vs uncuffed ETT: controversial<ref>https://pedemmorsels.com/cuffed-endotracheal-tubes-in-children/</ref> but cuffed tubes now genearlly considered acceptable<ref>American Heart Association. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, Vol. 122, Issue 18, Suppl 3; Novemeber 2, 2010.</ref>
-==Equipment/sizes/numbers==
+==Endotracheal Intubation==
 *ETT tube size:
 **Full term newborn - 3.5-4 uncuffed

ClaireLewis: /* Drugs */

2019-09-27T15:43:44Z

Drugs

← Revisión anterior		Revisión del 15:43 27 sep 2019
Línea 33:		Línea 33:
	*[[Atropine]] premedication		*[[Atropine]] premedication
	**Controversial		**Controversial
	**Neonates VERY prone to [[PALS:Bradycardia\|bradycardia]] with myriad stimuli, including the vagal stimulation of laryngoscopy		**Neonates VERY prone to [[PALS: Bradycardia\|bradycardia]] with myriad stimuli, including the vagal stimulation of laryngoscopy
	**May not be needed routinely but should at least have handy in case of bradycardia<ref>https://pedemmorsels.com/atropine-needed-rsi/</ref>		**May not be needed routinely but should at least have handy in case of bradycardia<ref>https://pedemmorsels.com/atropine-needed-rsi/</ref>
	**0.01-0.03 mg/kg IV/IO		**0.01-0.03 mg/kg IV/IO

ClaireLewis: /* Drugs */

2019-09-27T15:43:27Z

Drugs

← Revisión anterior		Revisión del 15:43 27 sep 2019
Línea 33:		Línea 33:
	*[[Atropine]] premedication		*[[Atropine]] premedication
	**Controversial		**Controversial
	**Neonates VERY prone to bradycardia with myriad stimuli, including the vagal stimulation of laryngoscopy		**Neonates VERY prone to [[PALS:Bradycardia\|bradycardia]] with myriad stimuli, including the vagal stimulation of laryngoscopy
	**May not be needed routinely but should at least have handy in case of bradycardia<ref>https://pedemmorsels.com/atropine-needed-rsi/</ref>		**May not be needed routinely but should at least have handy in case of bradycardia<ref>https://pedemmorsels.com/atropine-needed-rsi/</ref>
	**0.01-0.03 mg/kg IV/IO		**0.01-0.03 mg/kg IV/IO

ClaireLewis: /* Drugs */

2019-09-27T15:42:51Z

Drugs

← Revisión anterior		Revisión del 15:42 27 sep 2019
Línea 41:		Línea 41:
	**[[Fentanyl]] 1mcg/kg		**[[Fentanyl]] 1mcg/kg
	**[[Etomidate]] 0.3mg/kg		**[[Etomidate]] 0.3mg/kg
	*Paralytic- consider double dose in shock		*[[Neuromuscular blocking agents\|Paralytic]]- consider double dose in shock
	**[[Rocuronium]] 1.2mg/kg		**[[Rocuronium]] 1.2mg/kg
	***Preferred as may not yet be aware of preexisting conditions that would make sux contraindicated		***Preferred as may not yet be aware of preexisting conditions that would make sux contraindicated

ClaireLewis: Created page with "==General considerations== *Anatomical differences of neonates (compared to adults/big kids): Large occiput--> may need shoulder roll to get ear to sternal notch aligned R..."

2019-08-29T16:35:43Z

Created page with "==General considerations== *Anatomical differences of neonates (compared to adults/big kids): **Large occiput--> may need shoulder roll to get ear to sternal notch aligned **R..."

Página nueva

==General considerations==
*Anatomical differences of neonates (compared to adults/big kids):
**Large occiput--> may need shoulder roll to get ear to sternal notch aligned
**Relatively larger tongue, small mouth
**More anterior larynx
**Larger/floppier epiglottis
**Short trachea--> easy to mainstem tube, easy for accidental tube dislodgement

*Cuffed vs uncuffed ETT: controversial<ref>https://pedemmorsels.com/cuffed-endotracheal-tubes-in-children/</ref> but cuffed tubes now genearlly considered acceptable<ref>American Heart Association. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, Vol. 122, Issue 18, Suppl 3; Novemeber 2, 2010.</ref>

==Equipment/sizes/numbers==
*ETT tube size:
**Full term newborn - 3.5-4 uncuffed
**Preemie- gestational age in weeks/10 (e.g. 24-25wker gets a 2.5)
*Blade:
**Preemie <1.5kg: 00
**Full term newborn: 0
**Neonate/infant: 1
*ETT depth
**Newborn/neonate: uncuffed ETT x 3 (cm at lip)
**Preemie: weight in kg +1 (cm at lip)
*LMA size
**Weight in kg/20 + 1
*Apneic O2 by NC for newborn/neonate: 5L/m
*Routine vent settings
**FiO2 100%--> wean
**PEEP 4-5
**TV 8-10cc/kg
**RR 25-35
**I-time 0.5s

==Drugs==
*[[Atropine]] premedication
**Controversial
**Neonates VERY prone to bradycardia with myriad stimuli, including the vagal stimulation of laryngoscopy
**May not be needed routinely but should at least have handy in case of bradycardia<ref>https://pedemmorsels.com/atropine-needed-rsi/</ref>
**0.01-0.03 mg/kg IV/IO

*Sedation
**[[Ketamine]] ''not'' approved for <3mo <ref>https://reference.medscape.com/drug/ketalar-ketamine-343099</ref>
**[[Fentanyl]] 1mcg/kg
**[[Etomidate]] 0.3mg/kg
*Paralytic- consider double dose in shock
**[[Rocuronium]] 1.2mg/kg
***Preferred as may not yet be aware of preexisting conditions that would make sux contraindicated
**[[Succinylcholine]] 1.5mg/kg

==See Also==
*[[Neonatal resuscitation]], [[newborn resuscitation]]
*[[Pediatric jet ventilation]]
*[[The difficult airway]]

==External Links==

==References==
<references/>

[[Category:Procedures]]
[[Category:Pediatrics]]
[[Category:Critical Care]]

Neonatal intubation - Revision history

Rossdonaldson1: Redirected page to Intubation (peds)

Cdichang: /* Endotracheal Intubation */

Cdichang: /* Endotracheal Intubation */

Cdichang: /* Endotracheal Intubation */

Cdichang: /* Equipment/sizes/numbers */

ClaireLewis: /* Drugs */

ClaireLewis: /* Drugs */

ClaireLewis: /* Drugs */

ClaireLewis: Created page with "==General considerations== *Anatomical differences of neonates (compared to adults/big kids): **Large occiput--> may need shoulder roll to get ear to sternal notch aligned **R..."

ClaireLewis: Created page with "==General considerations== *Anatomical differences of neonates (compared to adults/big kids): Large occiput--> may need shoulder roll to get ear to sternal notch aligned R..."