Assessment and management of pediatric airway
Aim: The trainee should have an understanding of airway management in the pediatric trauma
patient.
Objectives:
Knowledge objectives:
The trainee should have acquired the following knowledge:
 An understanding of the anatomic and physiologic considerations of pediatric airway
management
 Use of optimal positioning of children, based on specific criteria (size and age) to
facilitate optimal airway control
 The differences between the adult and pediatric airway
 The current recommendations regarding the use of an uncuffed versus a cuffed endotracheal (ET) tube
 Have a comprehensive understanding of current practice guidelines for the precautions to
be taken prior to intubation, including:
o C-spine precautions,
o increased ICP,
o aspiration / cricoid pressure,
o pharmacological interventions (lidocaine, atropine, fentanyl)
 Alternatives and adjuncts available to facilitate oxygenation either prior to intubation, or
in the event of a failed airway:
o chin life,
o jaw thrust,
o bag-valve mask ventilation
o CPAP,
o oral airway, and
o surgical airway
 A thorough knowledge of rescue therapies in the event that one cannot intubate:
o Combitube
o Laryngeal mask airway
o Bougie
o Intubating bronchoscope
o Light wand
o Glidescope
o Retrograde intubation
 Indications and contraindications for immediate ET intubation
 Equipment necessary for successful ET intubation and its use
 An understanding of which size equipment is used for different ages
 The principles of rapid sequence intubation (RSI), including indications,
contraindications, and pitfalls to anticipate
 Common pharmacological agents used for RSI (their dosing, route of administration,
indications and contraindications), including
o sedatives,
o analgesics,
o muscle relaxants, and
o induction agents
 Major side effects of each of the pharmacological agents
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Have a thorough understanding of difficult airway algorithms such as that of the
American Society of Anesthesiology
Knowledge of post-intubation care to include basic ventilatory settings and how to tape
the ETT
Indications for awake intubation
Understand, anticipate, and manage post-intubation airway complications
Specific issues related to surgical airway on children (surgical cricothyroidotomy not
recommended for < 12 years)
Skills objectives:
The trainee should have an understanding of the following skill set:
 Non-invasive techniques for opening the airway, specifically chin-lift and jaw thrust
techniques
 Appropriate sizing of pediatric equipment based on age and weight
 Demonstrate the use of necessary equipment required for intubation
 Techniques for bag-valve mask ventilation
 Technique for intubation
 Understand and anticipate patients with a potentially difficult airway and the need for
airway expertise and management
 Technique for needle cricothyroidotomy
 Ability to identify proper placement of endotracheal tube