TYK376

You are called emergently to the delivery suite for a newborn in respiratory distress. Upon arrival, you see a dusky and floppy infant receiving positivepressure ventilation (PPV) by the on-call pediatric resident. You note that the stomach is not as expanded as you would have expected with vigorous PPV, but the chest is not moving well either. Of the following options, the BEST ACTION is:

a) Tell the nurse to call the NICU and surgical teams, and attempt to perform an awake intubation

b) Try to help the pediatric resident to form a better seal with the mask while observing for improved chest rise

c) Take over PPV and continue bagging until help arrives

d) Decompress the abdomen with the suction catheter, then reattempt PPV

e) Have the NICU team place umbilical lines before performing endotracheal intubation

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Answer

Answer a. This is a challenging clinical situation in a newborn with likely CDH. Rapid control of the airway with an endotracheal tube is critical to avoid insufflation of the stomach; in a floppy, cyanotic infant, immediate awake intubation is the best choice among the possible answers. Concurrently, help should be called from the NICU and surgery for escalation of management, but this should not delay airway management.

Notes

This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.

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