Pediatric emergency medicine trisk 0172 0172
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enhanced approach. An additional advantage of VL is the ability for multiple
practitioners to view the procedure simultaneously. This allows for real-time
guidance and supervision during TI. Oftentimes in emergency medicine, patients
require rapid airway management without the benefit of prescreening or
comprehensive airway assessments, and by providers who have less frequent
occasions to perform invasive airway procedures. Therefore, the recognized
advantages of VL may be underestimated in research studies.
A number of VL devices are available for use in pediatrics, varying in their
cost, design, reusability, and technique for use ( e-Table 8.1 ). Currently, only a
limited number offer sizing that allows for use across the entire spectrum of ages,
from neonates through to adolescents. The GlideScope and the Storz C-MAC are
currently the two most popular products in use in pediatric emergency medicine.
The GlideScope utilizes a J-shaped baton in conjunction with a hyperangulated
blade and a styletted ETT. Alternative GlideScope blades that enable DI are
currently available in adult but not pediatric sizes. The Storz C-MAC utilizes
more conventional blade geometry which closely mimics DI. Nonetheless, the
vantage point from the camera at the distal tip of the blade offers improved views
over those available directly. In addition, the C-MAC now has a pediatric and
adult hyperangulaged “D” blade that may be advantageous for patients in whom a
direct line of sight is likely to be challenging, as described above. King Vision
devices are newer videolaryngoscopes that also utilize a baton with disposable
single-use blades. The size 1 blade is unchanneled and requires concurrent use of
a styletted ETT. The pediatric and adult blades (sizes 2 and 3) come with either
channeled or unchanneled blades. The cost is significantly lower than the C-MAC
and GlideScope systems. There are other subtle differences that are beyond the
scope of this chapter and products in this market are constantly evolving to
improve.
PREOXYGENATION
Given the risk of rapid desaturation in children, efforts should be made to
maximize preoxygenation. Preoxygenation in children in the ED is traditionally
performed using a nonrebreather mask, which can be supplemented with a nasal
cannula. Flush rate oxygen delivery through a nonrebreather can limit
entrainment of room air during preoxygenation in adults, although it is not clear if
increasing flow beyond 15 liters per minute (L/min) is beneficial in younger
pediatric patients with smaller minute ventilation. Bag mask ventilation can be
used to increase the delivered FiO2 with positive pressure breaths. Spontaneously
breathing infants and young children may not have the inspiratory force to open
