Pediatric emergency medicine trisk 0162 0162
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (132.96 KB, 1 trang )
CHAPTER 8 ■ AIRWAY
JOSHUA NAGLER, AARON J. DONOGHUE, LOREN G. YAMAMOTO
GOALS OF EMERGENCY THERAPY
Tracheal intubation (TI) is a fundamental procedure during resuscitation of a
critically ill child. The goals of therapy are the placement of an artificial airway in
the trachea in a safe, expedient fashion, while simultaneously avoiding
physiologic deterioration (hypoxia, hypercapnia, bradycardia, hypotension).
TI is indicated for any clinical state where existing or impending failure exists
of oxygenation, ventilation, neuromuscular respiratory drive, or airway protective
reflexes. It may also be performed in critically ill patients in whom the projected
clinical course is concerning, or for patients requiring transport who are at risk for
deterioration. Reports in pediatrics have shown that the most frequent indications
for TI in children involve neurologic failure (traumatic brain injury, cardiac
arrest, status epilepticus) as opposed to primary respiratory failure, with trauma
accounting for more than half of all cases of pediatric TI in the emergency
department (ED). TI should be considered the definitive method of managing
existing or impending respiratory failure from any cause in the ED (see Chapter 9
Cardiopulmonary Resuscitation ).
Pediatric anatomy and physiology have direct influence on intubation
technique, equipment selection, and prevalence of adverse physiologic events
during TI. Table 8.1 summarizes the anatomic and physiologic features in
children that are important to consider when approaching TI in a child. The
summary effects of the various respiratory physiologic phenomena described
above are a greater tendency for hypoxemia and arterial desaturation, which must
be kept in mind during the preintubation and intubation phases of the procedure.
Quality and Safety
Despite the fact that TI is a fundamental, essential skill for emergency providers,
pediatric TI is an uncommon occurrence when measured at the level of an
individual provider. A survey of pediatric emergency department (PED) directors
found that the annual incidence of TI in the PED ranged from 12 to 64 cases per
year. Sixty-two percent of those surveyed believed that their faculty did not
encounter sufficient exposure to TI in their clinical duties to maintain competence
at this essential procedure. Additionally, the same survey found that there was a
negligible difference in the median number of TI cases per faculty at the PEDs
