Pediatric airway..Clinical pearls

When using Pediatric bougie there is concern about tracheal rupture and used when ETT size >3 mm.

To avoid bleeding from large adenoids, do not place nasal airway in child <1 yr of age

Always during transport apply cervical collar in child with ETT, even if just moving from one bed to another, to avoid displacement of ETT

Cuffed ETTs —now considered beneficial due to lower pressures.

Children highly dependent on diaphragm; once airway secured, insert nasogastric tube (NGT) or orogastric tube (OGT) as soon as possible to decompress stomach (NGT or OGT should be twice ETT size)

Proper bag-valve mask (BVM) technique — if attempting to use BVM on child with low O2 saturation, first action to place oral airway.

straight blade 0 used only in just-born newborn or premature infant, otherwise straight blade 1 used and shift to blade 2 at 2(years)..

2 times ETT size for NGT, OGT, and Foley catheter
3 times ETT size for tubes at lips
4 times ETT size biggest chest tube possibly needed for patient with

trauma

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Driving Pressure in ARDS: A new concept!

Driving Pressure and Survival in the Acute Respiratory Distress Syndrome Marcelo B.P. Amato, M.D., Maureen O. Meade, M.D., Arthur S. Slutsky, M.D., Laurent Brochard, M.D., Eduardo L.V. Costa, M.D., David A. Schoenfeld, Ph.D., Thomas E. Stewart, M.D., Matthias Briel, M.D., Daniel Talmor, M.D., M.P.H., Alain Mercat, M.D., Jean-Christophe M. Richard, M.D., Carlos R.R. Carvalho, M.D., and Roy G. Brower, M.D. N Engl J Med 2015; 372:747-755 February 19, 2015 DOI: 10.1056/NEJMsa1410639 BACKGROUND Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (V T ), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (C RS ) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size)...

Anaphylaxis updates part 2- Empty Ventricle Syndrome

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Epidural catheter tests...not only the test dose

Siphon test The catheter is held upright and a fluid level sought. If the catheter is then elevated, the fluid level should fall (see inset) as the fluid siphons in to the epidural space, which is usually under negative pressure compared with atmospheric. If the fluid column continues to rise, this may suggest subarachnoid placement. The siphon test can be reassuring, but is not mandatory. Aspiration This should be considered mandatory. The Luer connector is attached to the catheter and a syringe is used to apply negative pressure. Free and continued aspiration of clear fluid can indicate subarachnoid placement of the catheter. However, if saline has been used for loss of resistance, it is not unusual for a small amount of this to be aspirated. If there is doubt, the aspirated fluid can be tested for glucose (cerebrospinal fluid will generally test positive) or mixed with thiopentone (cerebrospinal fluid forms a precipitate). If blood is freely and continuously aspirated, this sug...

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