Diferencia entre revisiones de «Neonatal intubation»
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*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=" | {| class="Neonatal Endotracheal Intubation" | ||
|- | |- | ||
! Age !! Weight(kg) !! Cuffless !! Cuffed !! Depth(cm) !! Blade | ! Age !! Weight(kg) !! Cuffless !! Cuffed !! Depth(cm) !! Blade | ||
Revisión del 02:20 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
- Numbered list item
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
- Sedation
- 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
- Rocuronium 1.2mg/kg
See Also
External Links
References
- ↑ https://pedemmorsels.com/cuffed-endotracheal-tubes-in-children/
- ↑ 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.
- ↑ https://pedemmorsels.com/atropine-needed-rsi/
- ↑ 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 |