Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.


Pediatric Procedures

Sean Fox, M.D.
  • Remember that the pediatric larynx is anterior and cephalad, which makes the airway easy to occlude. Often a simple jaw thrust or shoulder roll is enough to open up the airway.
  • Basic Bag Valve Mask ventilation is a skill that must be mastered and done correctly: be aware, pushing too hard on the eyes can make your patient reflexively bradycardic and, hence, make your job more difficult.
  • There is no good data supporting or refuting lidocaine or atropine pretreatment in pediatric RSI. Much of the data is actually due to hypoxia as a cause for bradycardia, not vagal stimulation.
  • Studies showing increased ICP with ketamine were done on patients with malfunctioning VP shunts - and therefore obstructive hydrocephalus. Raising blood pressure in this case will cause increased ICP's.
  • Cuffed tubes are ok to use (recent American Heart Association publications support this) and may have a mechanical advantage when ventilating patients with pulmonary processes (ex. pneumonia, asthma).
  • Never forget to place an OG immediately after intubating. "Intubate the stomach!"
  • McGyver jet ventilator: 18ga angiocath, connector from a 3.0 ETT, 3mL syringe, and a 7.5 ETT
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