Diferencia entre revisiones de «Intubation (peds)»
Línea 27: Línea 27:
*3 blade in 3rd grade (8-9 yo)
*3 blade in 3rd grade (8-9 yo)


==Endotracheal tube Size==
==Equipment==
{| {{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;"|'''Miller'''
| align="center" style="background:#f0f0f0;"|'''Macintosh'''
| align="center" style="background:#f0f0f0;"|'''LMA Size'''
|-
| Preterm||<1||2.5||-||6 - 7||Miller 00 or 0||-||1
|-
| Preterm||1 - 2.5||3.0||-||7 - 9||Miller 0||-||1
|-
| Neonate||2.5 - 4||3.0||-||10||Miller 0||-||1
|-
| 6mo||6 - 7.5||3.5||3.0||10 - 11||1||-||1.5
|-
| 1 year||10||4.0||3.5||12||1||-||1.5
|-
| 2 - 3 y||12 - 14||4.5 - 5.0||4.0 - 4.5||13 - 14||1.5||-||2
|-
| 4 - 6 y||16 - 20||5.0 - 5.5||4.5 - 5.0||15 - 16||2||2||2
|-
| 7 - 9 y||22 - 26||5.5 - 6.0||5.0 - 5.5||16 - 18||2||2||2.5
|-
| 10 - 12 y||28 - 32||-||6.0 - 6.5||18 - 19||2||3||2.5 - 3
|-
| 13 - 15 y||34 - 38||-||6.5 - 7.0||19 - 20||2||3||3
|-
| 16 - 18 y||>40||-||7.0 - 8.0||21 - 24||2||3||3.5 - 4
|}
 
ETT Size:  (Age/4) + 4 for uncuffed, (Age/4) + 3.5 for cuffed
ETT Size:  (Age/4) + 4 for uncuffed, (Age/4) + 3.5 for cuffed


Línea 36: Línea 69:


*Cuffed and uncuffed ETT are acceptable outside neonatal age
*Cuffed and uncuffed ETT are acceptable outside neonatal age
**Uncuffed
***<1yo - 3.5mm ETT
***1-2yo - 4mm ETT
***>2yo - 4 + (age/4)
**Cuffed
***<1yo - 3mm ETT
***1-2yo - 3.5mm ETT
***>2yo - 3.5 + (age/4)
*Depth of Tube Placement: 3 x uncuffed ETT size (cm)
*Depth of Tube Placement: 3 x uncuffed ETT size (cm)
**Neonate: Nasal septum to tragus in cm + 1 cm
**Neonate: Nasal septum to tragus in cm + 1 cm

Revisión del 04:02 17 may 2020

See critical care quick reference for pre-calculated airway sizes by weight.

Airway Adjuncts

Airway Placement
Nasopharyngeal Tip of nose to tragus
Oropharyngeal From lip/teeth to angle of jaw
Bag valve mask 10cc/kg

LMA size = Wt(kg)/20 + 1

Apneic oxygenation

  • Infant: 5L/min
  • Child: 10 L/min
  • Adolescent/adult: 15 L/min

Blade Sizes

  • Preemie <1.4kg: 00
  • Newborn: 0
  • Neonate/infant: 1
  • 2 blade starting at 2 yo
  • 3 blade in 3rd grade (8-9 yo)

Equipment

Age Weight (kg) Cuffless Cuffed Depth (cm) Miller Macintosh LMA Size
Preterm <1 2.5 - 6 - 7 Miller 00 or 0 - 1
Preterm 1 - 2.5 3.0 - 7 - 9 Miller 0 - 1
Neonate 2.5 - 4 3.0 - 10 Miller 0 - 1
6mo 6 - 7.5 3.5 3.0 10 - 11 1 - 1.5
1 year 10 4.0 3.5 12 1 - 1.5
2 - 3 y 12 - 14 4.5 - 5.0 4.0 - 4.5 13 - 14 1.5 - 2
4 - 6 y 16 - 20 5.0 - 5.5 4.5 - 5.0 15 - 16 2 2 2
7 - 9 y 22 - 26 5.5 - 6.0 5.0 - 5.5 16 - 18 2 2 2.5
10 - 12 y 28 - 32 - 6.0 - 6.5 18 - 19 2 3 2.5 - 3
13 - 15 y 34 - 38 - 6.5 - 7.0 19 - 20 2 3 3
16 - 18 y >40 - 7.0 - 8.0 21 - 24 2 3 3.5 - 4

ETT Size: (Age/4) + 4 for uncuffed, (Age/4) + 3.5 for cuffed

  • Estimates cuffed
  • 1 yr, 10kg, size 4
  • 5 yr, 20kg, size 5
  • 10 yr, 30 kg, size 6
  • Cuffed and uncuffed ETT are acceptable outside neonatal age
  • Depth of Tube Placement: 3 x uncuffed ETT size (cm)
    • Neonate: Nasal septum to tragus in cm + 1 cm

Preemies

  • 1kg 2.5mm tube at 7 cm depth
  • 2kg 3.0mm tube at 8 cm depth
  • 3kg 3.5mm tube at 9 cm depth
  • OR tube size = Gestational age(wks)/10
  • Atropine
    • While atropine is not routinely recommended for pretreatment before RSI, it has been frequently used for infants younger than one year due to their predilection for bradycardia during RSI. However, rare cases of ventricular tachycardia and fibrillation have been seen in pretreatment of children, hence it is not recommended for this age group.[1][2][3]

Relation to Other Tubes

  • NG, OG, foley = 2 x ETT
  • Chest Tube (max) = 4 x ETT

Endotracheal Drug Delivery

  • Endotracheal Drug Delivery: 1:1000 solution at 0.1mg/kg = 0.1ml/kg
  • Newborn: 1:10,000 solution at 0.03mg/kg = 0.3mL/kg

See Also

References

  1. ↑ Fleming B, McCollough M; Henderson SO. Myth: Atropine should be administered before succinylcholine for neonatal and pediatric intubation. Can J Emerg Med 2005;7(2):114-7
  2. ↑ Tsou CH, Chiang CE, Kao T, et al. Atropine-triggered idiopathic ventricular tachycardia in an asymptomatic pediatric patient. Can J Anaesth 2004; 51:856
  3. ↑ Fastle RK, Roback MG. Pediatric rapid sequence intubation: incidence of reflex bradycardia and effects of pretreatment with atropine. Pediatr Emerg Care 2004; 20:651

Adapted from Pani, DeBonis

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