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Upper airway bronchoscopic approach and diagnostic procedures
Published in Don Hayes, Kara D. Meister, Pediatric Bronchoscopy for Clinicians, 2023
The ETT adapter must be removed, and the ETT must be stabilized (by forceps, the flexible bronchoscope, or an airway exchange catheter) during removal of the SGA. If a second, “pusher” ETT is used, it is grasped with pediatric Magill forceps or by an assistant and stabilized as the LMA is withdrawn. The second ETT is then cut as needed to eliminate dead space, and the ETT connector and ventilation circuit are connected.6
Recognition and Management of the Sick Child
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Julian Gaskin, Raymond W. Clarke, Claire Westrope
If an airway foreign body is likely and the child is in extremis, then immediate transfer to an operating theatre for removal of the object using a ventilating bronchoscope can be life-saving. An oropharyngeal foreign body may need to be immediately engaged and removed with Magill forceps.
General anaesthesia and failure to ventilate
Published in Daryl Dob, Griselda Cooper, Anita Holdcroft, Philip Steer, Gwyneth Lewis, Crises in Childbirth Why Mothers Survive, 2018
It is important that the first intubation is the best intubation attempt. In order to ensure this, an adequate dose of induction agent, such as thiopentone (4–7 mg/kg), is followed by 100 mg of suxamethonium (more may be required if the patient is very obese, e.g. 1–1.5 mg/kg). After 30 seconds (and not before, so that the drugs have time to work and the patient does not gag), insert the laryngoscope and intubate the trachea with an endotracheal tube of internal diameter 7 mm. It may be sensible to use the gum elastic bougie for the initial attempt at intubation. Successful intubation is confirmed by capnography and normal bilateral breath sounds. Cuff pressure may be measured with a cuff pressure gauge. This can avoid problems of overinflation leading to obstruction. If necessary, a long blade, a short-handle laryngoscope or a McCoy blade can be used for the first intubation. This will allow experience and expertise to be gained with these pieces of equipment before the need to use them when difficulties arise. The use of adult Magill forceps should also be learned.
Prehospital Pediatric Respiratory Distress and Airway Management Training and Education: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
John Lyng, Matthew Harris, Maria Mandt, Brian Moore, Toni Gross, Marianne Gausche-Hill, J. Joelle Donofrio-Odmann
EMS clinicians should be educated to intervene in pediatric patients with upper airway disturbances first with simple measures such as improving laminar airway flow by helping calm the patient. Then, as necessary and following a stepwise approach utilizing increasingly invasive interventions, the EMS clinician should progress to using medications such as inhaled epinephrine, intramuscular epinephrine, or steroids, and possibly ending with invasive procedures (19, 20). A caveat to this stepwise approach to treating upper airway disturbances would be immediate progression from abdominal thrusts and back blows to use of Magill forceps to relieve a complete foreign body upper airway obstruction.
Prehospital Pediatric Respiratory Distress and Airway Management Interventions: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
Matthew Harris, John W. Lyng, Maria Mandt, Brian Moore, Toni Gross, Marianne Gausche-Hill, J. Joelle Donofrio-Odmann
In the case of foreign body airway obstruction, Magill Forceps are the only rescue option if chest or abdominal thrusts fail. As a result, the value in obtaining and maintaining proficiency in this skillset by advanced EMS clinicians justifies provision of initial and ongoing psychomotor training (94, 95). Use of cadaveric and computer simulation models have been demonstrated as effective in establishing both initial and ongoing competency in these procedures among resident physicians and may have utility in the training of EMS clinicians (96, 97).