Intubation (peds)
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==[1]
| 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.[2][3][4]
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
- Critical care quick reference
- PALS (Main)
- Pediatric Vital Signs
- Practical pediatric RSI/vent algorithm: http://pemsource.org/wp-content/uploads/2016/11/RSI-and-Ventilator-Settings-Algorithm.pdf
References
- ↑ Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles Airway Card
- ↑ 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
- ↑ Tsou CH, Chiang CE, Kao T, et al. Atropine-triggered idiopathic ventricular tachycardia in an asymptomatic pediatric patient. Can J Anaesth 2004; 51:856
- ↑ 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