Health

What to consider if a patient deteriorates after endotracheal intubation?  If an intubated patient’s condition deteriorates after endotracheal intubation, consider DOPE: • D isplacement of the endotracheal tube—no longer in the trachea • O bstruction of the tube—perhaps by mucus • P neumothorax • E quipment failure—perhaps the ventilator is malfunctioning, or perhaps you are not actually delivering 100% oxygen as you thought …

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Can a difficult endotracheal intubation be predicted?  Not always, so it is important to have people experienced with airway management available, especially when a difficult intubation is anticipated. The conditions found in the below table often result in difficult intubations. Conditions Found in Difficult Intubations Congenital Acquired Micrognathia Hoarseness/stridor/drooling Macroglossia Facial burns/singed facial hairs Cleft …

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Why is cricoid pressure (Sellick maneuver) no longer recommended?  Cricoid pressure was recommended for rapid sequence intubation for many years as a means of preventing gaseous distention of the stomach from bag-valve-mask ventilation and passive regurgitation with aspiration during the intubation procedure. However, cricoid pressure can compress the trachea, making passage of the endotracheal tube …

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What are the steps for emergency endotracheal intubation of a child?  Begin bag-valve mask ventilation with 100% oxygen as soon as the need for positive-pressure ventilation is identified. Emergency endotracheal intubations are generally treated as “full-stomach” intubations. The steps for a rapid sequence intubation are as follows: 1. Preoxygenate with bag-valve-mask ventilation with 100% oxygen. 2. Prepare …

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What are the indications to intubate the trachea of a child? • Respiratory failure that is unlikely to be reversed quickly, especially if hypoxemia is present despite greater than 60% oxygen administration • Apnea, hypoventilation, or progressive respiratory exhaustion that requires ongoing mechanical ventilation • Need for airway protection for children who have upper airway obstruction or an …

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Is endotracheal intubation the only way to manage the airway when a child is in respiratory distress?  No. In fact, bag-valve-mask ventilation is adequate for many children with transient, reversible airway problems. Positioning the child with some extension of the neck and moving the mandible forward by lifting the angles of the jaw pulls the …

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Why are some patients who meet the definition for respiratory failure not intubated and mechanically ventilated to normalize their blood gases?  Children tolerate hypercarbia better than adults do. If oxygenation is adequate and hypercarbia is likely to be reversed in the near future, some intensivists permit the hypercarbia to persist for a period of time. …

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