Pediatrics

Difficult Airway

Diagnosis

Difficult Airway

Diagnosis

Difficult Airway

  1. Increase O2 to 100% and maintain continuous oxygen flow during airway management

  2. Call for help, surgical airway expert and cart, rigid bronchoscope and tracheostomy kit

  3. If unable to mask ventilate, ask for 2-handed assistance and:

    • Insert oral and/or nasal airway;
    • If unsuccessful, insert supraglottic airway (e.g., LMA)
    • Decompress stomach with orogastric tube
    • Consider reversing rocuronium or vecuronium with sugammadex (16 mg/kg)
    • 16 mg/kg

  4. If able to re-establish spontaneous ventilation:

    • Consider awakening patient
    • Consider reversal of neuromuscular blocker

  5. After two attempts: change providers and consider Alternative Approaches to Intubation

  6. If macroglossia (e.g. Beckwith-Wiedemann, Pierre-Robin), or mediastinal mass, consider prone or lateral position

  7. If still unable to ventilate:

    • Younger children: Emergency non-invasive airway such as rigid bronchoscopy
    • In older children: Jet ventilation or emergency invasive/surgical airway such as cricothyrotomy or tracheostomy

  8. Crisis Management (If Severe)

    Notify surgeon, call for help and code cart

  9. Call for Transesophageal Echocardiography

  10. Start chest compressions

  11. Give epinephrine 10 MICROgrams/kg IV/IO

  12. If cardiac arrest, go to CARDIAC ARREST

  13. Consider ECMO

Patient weight

Between 0.5 kg and 120 kg

Reset the checklist?

Checked steps, the timer and this crisis log are cleared. The patient’s weight is kept.

Finish the crisis?

The timer pauses, and you can review the case and the event log.