Re: peds intubation-- where did I go wrong???

["David Steele" <DSTEELE1@mn.rr.com>]

I have to ditto everything that has been said so far.  It is so important to
go back to the basics.  If you can't get it recognize the fact that we all
have those days.

  One of the things I constantly see is that the sphincter level is so high
with kids things that are always forgotten is proper positioning,  letting
the drugs work fully, taking time to do the laryngoscopy remember they
aren't going to die in 5 seconds so you don't have to get the tube in 5
seconds if you have preoxygenated them properly, Clear their airway with
suction and when you get the tube in hole the tube with your fingers to the
roof of the kids mouth and don't let go until it is secured (never).  All
very basic, but always things that get screwed up and lead to failure.  I
have seen docs, anesthestists try and try who aren't used to intubating kids
miss and we walk in who intubate kids frequently get it on the first time
only because of those issues above.  Technique is always the same.

With kids and bag valve masking the stomach can actually be so distended
that it impairs ventilation so it probably should always be decompressed at
one point or another.

I do have to disagree with Angie however I don't think Pediatrics are any
more or less difficult than any other age group as long as you know your
anatomy, differences and proper positioning I think sometimes it is even
easier...

David Steele RN Rotor Division
email   dsteele1@mn.rr.com
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