Pediatric Airway Presents Unique Challenges in Airway Management

Your aeromedical EMS crew is dispatched directly to a preschool for a patient with a possible head injury. The patient is a 4-year-old, 20-kg boy with known Hurler's syndrome who was struck in the head during a fall from a standing position. The school nurse arrived to find him unconscious, apneic and without a palpable pulse. She initiated CPR, which resulted in a palpable pulse, and continued ventilations via mouth-to-mouth until an ambulance arrived. On arrival of ground EMS, ventilations were continued via a bag-valve mask (BVM) and supplemental oxygen while C-spine precautions where maintained. Endotracheal (ET) intubation was attempted but the laryngoscope blade wasn't able to be placed into the patient's mouth. BVM ventilations were continued while the patient was placed on a long spine board and secured for transport. On arrival of your aeromedical crew, a quick assessment determines the patient needs to have his airway secured prior to the 45-minute air transport, but the patient's airway is predicted to be a difficult intubation. The boy has a large tongue with very limited mouth opening. Due to his anatomy and history, you anticipate difficulty with airway control, ventilation and oxygenation. BVM ventilation with high-flow oxygen is continued while a laryngeal mask airway (LMA Unique #2) as a rescue airway is readied. The surgical airway kit is also opened and made immediately ready. The patient receives atropine 0.02 mg/kg, etomidate 0.3 mg/kg, and rocuronium&nbs...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Airway & Respiratory Source Type: news