Airway Emergencies SBH Peds Res儿科急症气道 SBH PED水库课件.pptVIP

* * * * * * * * Need high index of suspicion if not improving, out of age range, unimmunized, especially if toxic appearing with high fevers. * * Minimal contact with the tongue. It is much less likely to induce emesis than an oral airway and is frequently tolerated by conscious patients. Thus, this device is particularly useful for children with soft tissue upper airway obstruction such as macroglossia or tonsillar hypertrophy, who have normal mentation and respiratory function. * * * Cricoid cartilage (the narrowest diameter of the pediatric airway) that could result in damage to the subglottic trachea * * Compared with C4 - C5 in adults Direct visualization of airway structures more challenging * Tongue More difficult to control during laryngoscopy Epiglottis - Straight blade to directly lift the epiglottis may be more effective for visualizing the glottic opening * * An anesthesiologist by the name of Patel did a great study which demonstrates some of these physiologic differences This study was done in 1994 Patel and colleagues took 50 healthy, ASA Class 1 patients who were undergoing elective surgery Patients ranged from 2 days to 18 years of age. They pre-oxygenated them as is standard practice in the OR They administered sedatives, and then neuromuscular blocking agents, and then they measured how long it took for the patients to desaturate to 90% Here is a table, with 5 groups of 10 patients each, categorized by age Look at the mean time to desaturation, in young infants it is in the neighborhood of 1.5 minutes By the time you reach school age, that number increases to more than twice that And for teenagers and adolescence, they behave much more like adults with a desaturation time of minimum of 3 minutes, but more commonly in the 6 minute range One might say, well I’m less worried about their sat getting to 90% as I am that it will get much less than that. Animal studies and mathematical models have allowed for prediction of the this time perio