Question

A 10-month-old girl was transported to the emergency department by paramedics. She has a history of fever and had a seizure at home. On arrival, the patient was not actively seizing, but she was apenic with an oxygen saturation of 75%. You position the head, open the airway, and, using the EC-clamp technique, you provide oxygen by a bag-valve-mask resuscitator. You suction the airway to remove oral secretions. At this time, the physician takes over manual ventilation and asks you to prepare for intubation. He would like an oral airway, with appropriate ETT size, stylet, and laryngoscope handle and blades. Using SOAPPIM, you prepare for intubation.

1. What size ETT, oral airway, stylet, and laryngoscope blades will you prepare for this patient?

   The patient is intubated without any adverse intubation-associated events.

2. How do you confirm endotracheal tube placement in the pediatric patient?

3. What other intubation device could have been used for this patient?

Answer 1

ENDOTRACHEAL INCUBATION

It is a medical procedure in which a tube is placed into the windpipe through the mouth or nose.In most emergency situation,it is placed through the mouth.

EET tube size of this patient:

-Preficted uncuffed tube size 4-4.5 mm tube

-Predicted cuffed tube size 3-3.5 mm tube

AIRWAY

The average diameter of the carotid cartilage in an infant is approximately 6 mm. Jismein Satya cross sectional area calculated as 3.14*9=28mm.Reduction of the pediatric airway by 1mm results in a reduced radius from 3mm to 2mm.

STYLET

a lighted style you said the principle of transillumination of the soft tissue of the handler method to guide the tip of the endotracheal tube into the trachea. This technique takes advantage of the anterior or more superficial location of the trachea in relation to the oesophagus.

The paediatric illuminated stylet with fit for comfortably into a 4.5 incubation tube and with lubrication into a 4.0 tube.Incubation stylet feature a satin-smooth coating and are available in three sizes for 2.4-4.5mm,5.0-7.5mm and 7.5-10.0mm endotracheal tube.

LARYNGOSCOPE BLADE

The proper size of a straight blade size is according to the patient age.

BLADE SIZE:

-Premature=0

-Neonates=0-1

-1 month to 2 yr=1

-2-6 yr=1-2

-6-12 yr=2

-Older than 12=2-3

COMPLICATION

-Many complications associated with the oral endotracheal tubes during initial placement.It also associated with a complication following placement that can occur during the days to weeks of ICU admission.

-Daily endotracheal tube care should be provided to avoid complications associated with EET.Daily care include monitoring of pressure,oral and endotracheal suctioning of secretion and vigilant inspection to ensure that EET is rotated regularly and his position maintained.

​​​​CONFIRMATION ENDOTRACHEAL TUBE PLACEMEPLACEMEN IN PEDIATRICS AND OTHER DEVICE

-End-tidal CO2 detection,usally with a colorimetric device is a standard of care for confirming tracheal placement of endotracheal tubes after emergency incubation.

-Other device such as self inflating bulb may be useful when carbon dioxide exchange is insufficient to be reliably detected as in case of prolonged cardiac arrest.

CONCLUSION

Here we discuss about:

-Size of EET,oral airway,style and laryngoscope blades.

-Complication associated with EET tube.

-Confirmation of EET tube placement in pediatric client and other devices used.