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Paediatric difficult airway management: Difference between revisions
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Paediatric difficult airway management (view source)
Revision as of 17:00, 12 February 2023
, 1 year ago→3. Cannot intubate, cannot ventilate (CICV) - ‘rescue techniques’
| Line 363: | Line 363: | ||
surgical cricothyroidotomy is preferable, so this is recommended in | surgical cricothyroidotomy is preferable, so this is recommended in | ||
older children. | older children. | ||
The important factor is that at least one technique is actually attempted | The important factor is that at least one technique is actually attempted | ||
by someone in the CICV situation when the oxygen saturations are | by someone in the CICV situation when the oxygen saturations are | ||
| Line 368: | Line 369: | ||
The CICV situation is a particular challenge in infants and small | The CICV situation is a particular challenge in infants and small | ||
children, due to important anatomical differences: | children, due to important anatomical differences: | ||
• The trachea is small, elastic, flaccid and mobile, and so prone to | :• The trachea is small, elastic, flaccid and mobile, and so prone to collapse during insertion of a transtracheal device. | ||
collapse during insertion of a transtracheal device. | :• The cricothyroid membrane is much smaller, with an average size of only 2.6 x 3mm, smaller than the smallest tracheal tubes. | ||
• The cricothyroid membrane is much smaller, with an average size | :• It is more difficult to locate the cricothyroid membrane than in adults due to a differing orientation of the hyoid bone and the cricoid and thyroid cartilage. This orientation also increases the chance of laryngeal trauma during cricothyroidotomy. | ||
of only 2.6 x 3mm, smaller than the smallest tracheal tubes. | :• It is easier to locate the space between the tracheal rings rather than the cricothyroid membrane. | ||
• It is more difficult to locate the cricothyroid membrane than in | |||
adults due to a differing orientation of the hyoid bone and the | |||
cricoid and thyroid cartilage. This orientation also increases the | |||
chance of laryngeal trauma during cricothyroidotomy. | |||
• It is easier to locate the space between the tracheal rings rather | |||
than the cricothyroid membrane. | |||
Together these factors mean it may be more appropriate in infants | Together these factors mean it may be more appropriate in infants | ||
and small children to perform a surgical tracheostomy. | and small children to perform a surgical tracheostomy. | ||
All ‘rescue techniques’ have significant potential for complications so | All ‘rescue techniques’ have significant potential for complications so | ||
should only be performed in life threatening situations. Clearly, all the | should only be performed in life threatening situations. Clearly, all the | ||