Pediatric emergency medicine trisk 0199 0199
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patients should be monitored continuously with pulse oximetry, ETCO2 , and
cardiorespiratory monitors.
MANAGEMENT
Airway Positioning
If cervical trauma is suspected, the head and cervical spine must be stabilized
during all airway maneuvers. Airway obstruction is most often related to
relaxation of the jaw and neck muscles causing the tongue and mandibular tissues
to fall posteriorly against the posterior wall of the hypopharynx. Airway
positioning maneuvers, such as the head tilt–chin lift and the jaw thrust, are used
first to relieve obstruction ( Fig. 9.4 ). Jaw thrust alone is used if cervical
stabilization is needed.
Artificial Airways
If airway positioning fails to relieve obstruction, oropharyngeal (OPA) or
nasopharyngeal artificial airways (NPA) may be used.
Oropharyngeal Airways
Estimate OPA size by placing it against the side of the child’s face; with the
flange at the corner of the mouth assuring that the tip ends just proximal to the
angle of the mandible; use a tongue depressor to insert, or insert sideways and
rotate into place to avoid damage to the soft tissues ( Fig. 9.5 ). OPAs are used in
unconscious patients only. If the OPA is too short, it may push the tongue
backward into the posterior pharynx aggravating airway obstruction. If the OPA
is too long, it may touch the larynx and stimulate vomiting or laryngospasm.
Nasopharyngeal Airways
The correct NPA size covers the distance from the nares to the tragus of the ear (
Fig. 9.6 ). The NPA can be used in conscious patients. The NPA may lacerate the
vascular adenoidal tissue, thus adenoidal hypertrophy and bleeding diatheses are
relative contraindications to the use of these airways.
Endotracheal Tubes
Endotracheal (ET) tubes are used to overcome upper airway obstruction, isolate
the larynx from the pharynx, allow mechanical aspiration of secretions from the
tracheal bronchial tree, and facilitate mechanical ventilation or end-expiratory
pressure delivery (see Chapter 8 Airway ).
