How to find child equipment based on given age ?
Find estimated weight by age on pch website / AID trolley cards
Grab PAWS pack weight based and bring ACE trolley with RSI checklist
What to prepare before the child arrives
SOAPME
- Suction with yankauer or nasal suction from paws pack
- Oxygen: BVM connect to ETCO2 (neonate 250ml, paeds 500ml, big child/adult 1500ml). NP. NRM.
- Airway: OPA. NPA. ETCO2 adapter. Laryngoscope. Stylet. ETT (check inflation).
- cuffed (age/4)+4
*uncuffed (age/4)+3.5
*size 0.5 above and below
Syringe (10ml). LMA. Bougie. *difficult airway plan. Pressure meter. Lube.
*trouser leg TAPE - Pharmacological agents: sedatives, analgesic, paralytic.
Sedative: propofol, ketamine, midazolam
Analgesic: morphine, fentanyl
Paralytic: suxamethonium, vecuronium, rocuronium
Atropine + metaraminol
- Monitoring equipment: Sats, CO2, ECG, BP, IVC, NGT, BSL, Temp
What to do when patient arrives ?
Danger: safe to commence
Response: check whether pt is responding
Send for help: code blue paediatric
Airway: LEON
- look for trauma/ deformity
- doctor evaluate 332: difficulty of intubation
- obstruction/obesity
- neck mobility
- infant (under 1yr): neutral head + jaw support
- child: head tilt + sniffing
- suction if required
- opa central lips to angle for mandible
Breathing: look listen feel > 2 initial rescue breaths> check signs of life > if not CPR 15:2
- check O2sats check RR
- give doctor BVM with ETCO2
Circulation: check HR+ feel brachial/femoral pulse.
- CPR - infants 2 fingers, child 1 hand
- apply defib
- gain access: IVC IO ARTLINE
- VBG/ABG
Disability: GCS, BSL
E: temp, external trauma
Set up for RAPID SEQUENCE INTUBATION (RSI)
- Suction
- Cricoid pressure
- Laryngoscope (Straight/curved) 📐
- lubricated ETT with stylet in it
- Bougie back up
- LMA back up
- BVM with ETCO2 To patient
- Auscultate chest to see air entry equal/ not in belly
- CUFF UP
- tape trouser legs
- set up ventilator what they say and start
- Cobb’s > ETCO2 > hme filter > ventilator
- CXR
Settings for ventilator
Ventilator set to:
- Paeds/adult
- set to estimated weight
*Tidal Volume: the amount of air a person inhales during a Normal breath of air.
Set it to ensure adequate ventilation without causing trauma to lungs.
* calculate SIMV: 6-8ml/kg. NIV:4-6ml/kg
* RR normal range 20-30
*I:E ratio (inspiration to expiration ratio)
*insp time: 0.5-0.6
- pressure support: when patient can breath but isn’t able to get sufficient VT, supports them on inspiration to get enough O2 (10)
- minute volume: RR x VT
- PEEP : positive end expiratory pressure. Use to open up the alveoli and provide better gas exchange. Good for patients with APO allow fluids in lungs to escape (5)
Post intubation care
- fill in mechanical invasive ventilation form
- obs 15/60 firs hour or everytime they change settings
- post intubation sedation infusion :propofol
- blous if patient ^ in agitation score
- NGT
- IDC
