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Anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Note the  ā„¦  shape Unformed hyoepiglottic ligament  Can not compress  as easy with a mac blade to move epiglottis indirectly
Epiglottitis
Physiology ,[object Object],[object Object],[object Object],[object Object]
Equipment/ Medications ,[object Object],[object Object],[object Object],[object Object],[object Object]
Equipment ,[object Object],[object Object],[object Object],Deakers TW, Reynolds G, Stretton M, et. Al. Cuffed ETT in pediatric intensive care. L Pediatr  1994; 125:57-62 Khine HH, Corddry DH, Kettrick RG, et al. Comparrison of cuffed and uncuffed ETT in young children during general anesthesia.  Anesthesiology  1997; 86:627-631
Intubation Process ,[object Object],External canal lies just anterior to the shoulder
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],RSI
Intubation Continued ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Post-Intubation ,[object Object],[object Object],[object Object],[object Object]
Plan B, C,D ,[object Object],[object Object],[object Object],[object Object],[object Object]
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You arrive on scene to find a 4 year old male in the care of his mother. Mom reports the child has become progressively more ill over the last 24 hours. You observe the child drooling, sitting forward in a tripod position and refuses to sit back. He feels warm to the touch, RR: 36 with mild retractions, HR: 130, Skin: Pink, warm and dry with refill < 2 seconds, palpable peripheral pulses. He appears ill and talks with stridor (hot potato voice) What is the issue?
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Causes, Occurence ,[object Object],[object Object],[object Object]
Epiglottitis Normal
Croup is an infectious illness of the respiratory system involving the voice box and vocal cords. A harsh crowing sound (&quot;stridor&quot;) during inhaling can be heard when the child's air passage becomes abnormally narrowed
[object Object],[object Object],[object Object],[object Object],Croup
Croup/Epiglottitis Treatment? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Swelling from Croup
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PPV PPV PPV will help open that obstruction even in a child in complete respiratory arrest.
RSV Respiratory Syncytial Virus ,[object Object],[object Object],[object Object],[object Object],[object Object]
RSV Treatment Treating respiratory syncytial virus bronchiolitis &quot;remains a good example of therapeutic nihilismā€”nothing works except oxygen&quot;. Adrenaline, bronchodilators, steroids, and ribavirin confer &quot;no real benefitā€œ Treatment is supportive care only, with fluids and oxygen until the illness runs its course
Albuterol may be used in an attempt to relieve any bronchospasm if present. Increased airflow, humidified and delivered via nasal cannula, may be supplied in order to reduce the effort required for respiration. Recent studies with hypertonic saline have shown that the &quot;use of nebulized 3% HS is a safe, inexpensive, and effective treatment for infants hospitalized with moderately severe viral bronchiolitis&quot; where &quot;respiratory syncytial virus (RSV) accounts for the majority of viral bronchiolitis cases&quot;
^  Jenny Handforth, Mike Sharland, Jon S Friedland. Editorial: Prevention of respiratory syncytial virus infection in infants. BMJ 2004;328:1026ā€“1027 (1 May), doi:10.1136/bmj.328.7447.1026

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Pediatric respiratory

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  • 4. Note the ā„¦ shape Unformed hyoepiglottic ligament Can not compress as easy with a mac blade to move epiglottis indirectly
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  • 15. You arrive on scene to find a 4 year old male in the care of his mother. Mom reports the child has become progressively more ill over the last 24 hours. You observe the child drooling, sitting forward in a tripod position and refuses to sit back. He feels warm to the touch, RR: 36 with mild retractions, HR: 130, Skin: Pink, warm and dry with refill < 2 seconds, palpable peripheral pulses. He appears ill and talks with stridor (hot potato voice) What is the issue?
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  • 19. Croup is an infectious illness of the respiratory system involving the voice box and vocal cords. A harsh crowing sound (&quot;stridor&quot;) during inhaling can be heard when the child's air passage becomes abnormally narrowed
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  • 24. PPV PPV PPV will help open that obstruction even in a child in complete respiratory arrest.
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  • 26. RSV Treatment Treating respiratory syncytial virus bronchiolitis &quot;remains a good example of therapeutic nihilismā€”nothing works except oxygen&quot;. Adrenaline, bronchodilators, steroids, and ribavirin confer &quot;no real benefitā€œ Treatment is supportive care only, with fluids and oxygen until the illness runs its course
  • 27. Albuterol may be used in an attempt to relieve any bronchospasm if present. Increased airflow, humidified and delivered via nasal cannula, may be supplied in order to reduce the effort required for respiration. Recent studies with hypertonic saline have shown that the &quot;use of nebulized 3% HS is a safe, inexpensive, and effective treatment for infants hospitalized with moderately severe viral bronchiolitis&quot; where &quot;respiratory syncytial virus (RSV) accounts for the majority of viral bronchiolitis cases&quot;
  • 28. ^ Jenny Handforth, Mike Sharland, Jon S Friedland. Editorial: Prevention of respiratory syncytial virus infection in infants. BMJ 2004;328:1026ā€“1027 (1 May), doi:10.1136/bmj.328.7447.1026