Pediatric Airway review, tips, and resources

[Angry Birds]

I just realized I haven’t tubed a kid in ages and need to review.

So, what meds do you guys routinely use?
What device? I realized I haven’t done DL in ages.

Any good tips?

What are some good resources for me to review?

I’m turning into a dinosaur.

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[Angry Birds]

Oh man, I’m so predictable of a person. I made the exact same thread in 2014.
Haha no replies in that thread so here is me asking again ten years later.

 

[Apollyon]

Broselow?

 

[Tenk]

I had a tube a 15 month old the other day and I forgot how useless pediatric stylets are. I pretty much use exclusively video laryngoscopy and in particular the glide scope at my shop. I had no problem with view but tube was floppy. Still got it first try but was nerve wracking. Anyways, I looked online afterwards and glidescope makes a stylet for smaller tubes that’s nice and rigid. I had my department order some. They are great. I’d check those out if you use any video laryngoscopy. Cheers.

 

[Groove]

I don't think any of us are tubing pediatric patients on the regular but I've always felt that kids are the easiest airways. An airway course I went to one time reiterated the same thing. I've always used DL, miller, roc and etomidate. The only thing I don't like is that kids desat super fast which adds a certain pucker factor.

That's hilarious that you posted that thread in 2014 and nobody responded. LOL.

 

[Mount Asclepius]

I've intubated 4 kids in the past 5 years looking at my most recent procedure numbers. I still keep track for who knows what good reason other than curiosity. Agree it's super rare. Less than once per year for me. While rare and a little nerve wracking, I'm usually surprised how easy it is to achieve a decent DL view. Typically DL (limited VL pediatric equipment at our shop, but I should probably work on addressing), Miller blade (usually easiest available for pediatric sizes, although I prefer Mac due to familiarity even in kids), Rocuronium, and Etomidate/Ketamine. The nurses still break out the Broselow, but I like the Pedi STAT app.

 

[RustedFox]

I’m turning into a dinosaur.

I thought it was the dinosaurs that turned into the birds, not the other way around. XD.

 

[Radetzky]

I just realized I haven’t tubed a kid in ages and need to review.

So, what meds do you guys routinely use?
What device? I realized I haven’t done DL in ages.

Any good tips?

What are some good resources for me to review?

I’m turning into a dinosaur.

Same meds as adults
There is a paucity of VL in pediatric sizes, whether you use straight blade or MAC blade probably doesn’t matter as long as you lift up the entire epiglottis with the blade, rather than trying to get in the vallecula (in infants)

There are apps where you can plug in age/weight and it tells you what size tube and how deep.

Always put down an NG tube if possible before tubing. If multiple attempts, assign someone to stand next to the NG with a syringe and continuously aspirate it
Always bag them while waiting for paralysis to work
airway difficulty is proportional to how funny looking the kid is

 

[Rendar5]

I just realized I haven’t tubed a kid in ages and need to review.

So, what meds do you guys routinely use?
What device? I realized I haven’t done DL in ages.

Any good tips?

What are some good resources for me to review?

I’m turning into a dinosaur.

Not a dinosaur if you haven’t done DL in ages. It’s still a new thing that people stopped doing DL in favor of VL.

I actually worry about this current generation of residents who don’t do enough DL to get facile (not worried about those who got sufficient training). I don’t usually let my residents do VL (since most attendings let them intubate however they are comfortable). . DL is a harder skill to learn and is needed every now and then. I need to make sure they can do DL when it is needed. You don’t want to run into difficulties the 1% of the time something screws up with the VL equipment (three times in 10+ years. 2 missing/inappropriate equipment pieces and 1 screen on the fritz)

I swear that number of procedures needed to graduate should distinguish between the two methods. Something like 30 DL and 5 VL. I was actually horrible at intubating until I got to around 20.

 

[BoardingDoc]

A bit off topic but while we’re discussing uncommon things, do you guys remove corneal foreign bodies or don’t and just refer to optho? Had one recently. I called optho and they said follow up in clinic and dc regardless of whether I can remove and didn’t come in. I offered to remove (no concern for globe rupture) and patient asked how many I’ve done. I hadn’t done one since 2nd year of residency. He’s like nope I’ll follow-up with optho. So I dced him.

I will tetracaine and qtip swab it out if not embedded at all. I've stopped bothering trying to flick it out with a 25g. Haven't done that in probably 5 years. Never used a burr and never intend to. Simply isn't an emergency and they're better off having ophtho do it.

 

[Mount Asclepius]

I usually briefly try to remove eye foreign bodies in escalating fashion following Proparacaine/Tetracaine with Q-tip, needle and then burr drill. I don't waste a ton of time trying though. These can be managed as an outpatient with follow-up with Ophthalmology. Symptomatically they are miserable though and so I feel its worth me taking two seconds of trying rather than make them wait even 1-2 days to be seen in clinic.

Many foreign bodies in general though can be managed as outpatients. From my training I was led to believe they all needed to be removed in the ED. Other than things like button battery or magnet ingestions, most can just followup.

 

[Rendar5]

Q tip, needle under slit lamp, followed by “not me.” If there’s a rust ring that goes to ophtho anyway

 

[Angry Birds]

I waited ten years for an answer and now someone is asking about corneas.

Jk 😂

 

[Angry Birds]

I usually briefly try to remove eye foreign bodies in escalating fashion following Proparacaine/Tetracaine with Q-tip, needle and then burr drill. I don't waste a ton of time trying though. These can be managed as an outpatient with follow-up with Ophthalmology. Symptomatically they are miserable though and so I feel its worth me taking two seconds of trying rather than make them wait even 1-2 days to be seen in clinic.

Many foreign bodies in general though can be managed as outpatients. From my training I was led to believe they all needed to be removed in the ED. Other than things like button battery or magnet ingestions, most can just followup.

Discharge with tetracaine with strict instructions to dispose in 24 hours

 

[Apollyon]

Discharge with tetracaine with strict instructions to dispose in 24 hours

And patients always do that!

(Except when they don't)