Surgical Airway in Children

Most of us know how to perform a surgical airway in adults, and the basic principles are the same in children.

The Royal Children's Hospital has an excellent airway manual here, with instructions on how to perform a surgical airway in children. Uptodate has a step to step guide.

There are lots of different methods of performing a surgical airway. Chose a method you are familiar with, and that you have the kit for in your hospital.

Choking

Choking is in the PEM syllabus, and is a really easy thing to learn. Unfortunately, medics are often notoriously bad at basic first aid!

Resus Council Guidelines
Page 26
Paediatric Algorithm
Adult Algorithm
- Remember - 5 back blows first (the terminology is important to emphasize the force needed).
- Then 5 abdominal thrusts
- If the patient becomes unconscious, you should start chest compressions, even if they have a carotid pulse.

These excellent videos show why it is important to know how to deal with choking:

St John Ambulance Popcorn Video
St John Ambulance Helpless Video
St John Ambulance - Abigail

First Aid Advice:
St John written advice
St John video advice
Red Cross video advice
Excellent divisional summary from St John Ambulance


Choking Presentation

There is a good journal article here (Pediatrics 2013;132;275; originally published online July 29, 2013), listing what children commonly choke on. You won't be surprised to learn that sweets are a common culprit!

The airway in children

Before we started to think about how to recognise a problematic airway, it is useful to think about the airway of a child, and how this differs from adults.

This page has a nice summary. It's written for anaesthetists so has more information than we'll need to know (hopefully!).There's a very good summary here and here, with some practical suggestions.

LITFL has not let us down, and they also have an excellent summary together with some management tips. e-LfH has a module about stridor.

There is a very thorough powerpoint presentation all about the difficult airway in children here. The pictures are well placed, and makes you realise that children really aren't just little adults.

Basically, children are much more likely to have difficult airways, and have a high anterior larynx. There are lots of pictures that demonstrate these differences really well:



http://www.ceu-emt.com/images/childadultupperair.gif

This is a really good overview, with every difference labelled on a very clear picture.

http://www.revcolanest.com.co/en/la-via-aerea-pediatrica-algunos/articulo/90149961/


There is a nice little case based e-learning module on doctors.net here:
http://www.doctors.net.uk/ecme/wfrmNewIntro.aspx?moduleid=1562
It is a useful reminder of some of the common, and not so common, airway problems in children. 

Ventilate - which ever way you can!

An Epiglottitis Case...

Like all things, this case is theoretical but you can always trust Life in the Fast Lane to have information on anything and everything!

A sick two year old with stridor - what would you do?



Above frame taken from: http://lifeinthefastlane.com/2010/06/intubation-of-a-toddler-with-airway-obstruction/

If you thought that sounded easy...have a look at this page from EP monthly - all about intubating a patient with epiglottitis.

(Comments disallowed on this page - please comment on the original post)

Epiglottitis

Epiglottitis isn't something that we see a lot of. There's nothing (yet) about it on Enlighten me, and e-learning modules on it are scarce. That is probably because it's not very common. But when we do see it, it is life threatening.

There is a great picture here of what a larynx is supposed to look like in epiglottitis. This would explain the symptoms, and why we worry about it.

Epiglottitis is caused by Haemophilus influenza B type. 15% of HIB cases present with epiglottitis. The "green book" has excellent information on immunisation, and tells you everything you'd ever want to know about HIB.



The above frame was taken from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/147953/Green-Book-Chapter-16.pdf

If you'd actually like to learn about epiglottitis, there is an American tutorial here.

Apnoea, stridor and airway and obstruction

For more blog posts and information on PMP2, click here. 

The college syllabus is well defined:

These are tricky subject areas to find information on, and very rare in practice.
For the allergic causes of airway obstruction, visit the anaphylaxis page.

For more airway posts, click here.

 

For more epiglottitis posts, click here. 

 

For more choking posts, please click here.

For more surgical airway posts, please click here. 

For more tonsillectomy posts, please click here.