Diferencia entre revisiones de «Neonatal intubation»
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! Age !! Weight(kg) !! Cuffless !! Cuffed !! Depth(cm) !! Blade
! Age !! Weight(kg) !! Cuffless !! Cuffed !! Depth(cm) !! Blade
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| Preterm || <1kg || 2.5 || - || 6-7 || Miller 0
| Preterm || <1kg || 2.5 || - || 6-7 || Miller 00 or 0
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| Preterm || 1-2.5 || 3.0 || - || 7-9 || Miller 0
| Preterm || 1-2.5 || 3.0 || - || 7-9 || Miller 0
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| Neonate || 2.5-4 || 3.0 || - || 10 || Miller 0
| Neonate || 2.5-4 || 3.0 || - || 10 || Miller 0
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*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
*ETT depth
**Newborn/neonate: uncuffed ETT x 3 (cm at lip)
**Newborn/neonate: uncuffed ETT x 3 (cm at lip)

Revisión del 02:19 17 may 2020

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[1] but cuffed tubes now genearlly considered acceptable[2]

Endotracheal Intubation

  • 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[3]
    • 0.01-0.03 mg/kg IV/IO

See Also

External Links

References

  1. ↑ https://pedemmorsels.com/cuffed-endotracheal-tubes-in-children/
  2. ↑ 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.
  3. ↑ https://pedemmorsels.com/atropine-needed-rsi/
  4. ↑ https://reference.medscape.com/drug/ketalar-ketamine-343099
Age Weight(kg) Cuffless Cuffed Depth(cm) Blade
Preterm <1kg 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
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