Pediatric emergency medicine trisk 0171 0171
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the clinician. Curved blades are designed to follow the base of the tongue into the
vallecula. They often have a beaded tip to allow pressure against the
hypoepiglottic ligament which helps to elevate the epiglottis. They also have a
large flange which facilitates displacement of the tongue. Straight blades allow
direct lifting of the epiglottis to expose the glottic opening. This type of blade
may be preferred in infants and younger children in whom the epiglottis is often
larger and more likely to fall into the line of sight.
Selecting the appropriate laryngoscope blades size allows the clinician to
control the tongue and reach the glottic structures. Age-based guidelines, lengthbased resuscitation tapes, anatomic landmarks, and electronic applications, can be
used to select an appropriate size. Although size 00 and 0 blades are used in
neonatology, blades smaller than a size 1 are rarely required in emergency
medicine. Size 1 blades can be used in patients less than 2 years of age. Size 2
blades are commonly used in children starting at 2 years of age. Size 3 blades are
commonly used beginning around 10 to 12 years of age. Selecting a laryngoscope
blade that approximates the distance between the upper incisors and the angle of
the mandible can be used as a guide in patients whose age is not known or when
the anatomy appears incongruous with the proposed blade size based on other
available references.
Video Laryngoscopes
VL utilizes video camera technology to further facilitate TI. Traditional direct
laryngoscopy (DL) requires the creation of a direct line of sight through the
mouth to the glottic opening. This is achieved by positioning the patient in the
sniffing position to align the oral, pharyngeal, and tracheal axes and then lifting
the tongue and soft tissue anteriorly using a laryngoscope. VL provides a vantage
point from behind the base of the tongue, through a camera chip built into the
device. As such, operators can view the glottis on a monitor screen around the
natural curvature of the upper airway, obviating the need to align the axes or
displace the tongue. Data support that videolaryngoscopes commonly offer
improved laryngeal views over DL, and may be particularly valuable in cases
where creating a direct line of sight may be challenging (e.g., cervical spine
collars, macroglossia, micrognathia). Some studies suggest that intubation
success rates are higher with VL compared to DL, though benefits may not be
noted in routine cases performed by experienced providers, in whom DL success
rates are high. Data regarding time to successful intubation using VL are varied in
pediatric populations. Advantages of VL are most notable in (1) novice clinicians
who may not have developed intrinsic skill with DL, and (2) patients with
difficult airways where the ability to gain an adequate view is favored by a video-
