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Pediatric Airway Emergencies:Evaluation and Management
Shashidhar S. Reddy, MD, MPH
Ronald Deskin, MD
January 2002
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Anatomic and Physiologic Considerations of the Pediatric Airway:
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Initial Assessment:
Signs of impending respiratory failure: Reduced level of consciousness or lethargy Quiet, shallow breathing Apnea
The above require immediate progression to endoscopy and/or intubation.
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History:
Description of OnsetAge at onsetHistory of foreign body aspiration/ingestionAggravating factors: feeding/sleepingHistory of intubationBirth history (syndromes, birth trauma)
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Physical Exam:
InspectionAscultationRepositioning
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Flexible Laryngoscopy:
Proper EquipmentAssess nares/choanaeAssess adenoid and
lingual tonsilAssess TVC mobilityAssess laryngeal
structures
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Radiology:
Plain films: Chest and airway AP and
lateral Expiratory films High vs. low kilovoltage
FluoroscopyBarium SwallowCT, MRI, Angiography
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Flexible Bronchoscopy:
Does not require general anasthesiaMainly diagnostic purposesLimited intervention (e.g. suctioning)Can be used for intubationLimited airway control
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Direct Laryngoscopy andRigid Bronchoscopy
Indications: Severe or progressive airway obstruction No diagnosis after flexible laryngoscopy and
radiology Subglottic pathology suspected
Advantages over flexible bronchoscopy: Better control of the airway
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Direct Laryngoscopy
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Direct Laryngoscopy
Insufflation technique:
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The Ventilating Bronchoscope
A. Light source and telescopeB. Prismatic light detector and
attachment to light sourceC. Aspiration and
instrumentation channelD. Connector to anesthesiaE. Telescope bridge
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Rigid Bronchoscopy
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Rigid Bronchoscopy:
Complications: Loss of airway control Injury to subglottic space Damage to teeth or gums Airway bleeding Pneumothorax Failure to recognize pathology
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Specific Etiologies of Airway Emergency
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Laryngotracheobronchitis
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Bacterial Tracheitis (Membranous Tracheitis)
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Epiglottitis
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Choanal Atresia
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Pyriform stenosis
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Laryngomalacia
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Vocal Cord Paralysis
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Subglottic Stenosis
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Subglottic Hemangioma
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Tracheoesophageal Fistula
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Laryngeal Cleft
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Vascular Anomaly
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Recurrent Respiratory Papillomatosis
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Airway Foreign Bodies
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Case Study: History
Consult from the Neonatal ICU: Newborn infant in increasing respiratory
distress since birth. Oxygen saturation is now 100%, but the child
has begun to use accessory muscles. Feeding aggravates the distress. Infant has a weak cry, and pediatritians notice
noisy breathing. No abnormal birth history.
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Case Study: Physical Examination
Newborn female infant supine in the bed, sat’ing 100% on room air
Moderate use of accessory musclesModerate biphasic stridorAudible breaths through both naresRepositioning has little effect on stridor
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Case Study: Endoscopy
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