What’s Your Diagnosis? Supraglottic Airway Devices for Pediatric Airway Management in the ED
September 22, 2020
Posted by Andy Jagoda MD in: What's Your Diagnosis , trackback
Welcome to this month’s What’s Your Diagnosis Challenge!
But before we begin, check to see if you got last month’s case on Emergency Care for Transgender and Gender-Diverse Children and Adolescents right.
Case Presentation: Supraglottic Airway Devices for Pediatric Airway Management in the ED
You are working in the ED when EMS arrives with a 4-year-old boy who is in respiratory distress. The paramedics report that the boy was seen earlier at an urgent care center and was diagnosed with influenza A by point- of-care testing. On examination, you note a visibly smaller mandible and a tongue set farther back than its typical position. His mother confirms that the boy has Pierre Robin sequence.
As the patient is placed on a stretcher, you note that he is tired appearing, with significant nasal congestion and micrognathia. His vital signs are notable for a fever of 39.6?C (103.3?F), respiratory rate of 14 breaths/min, and oxygen saturation of 88% on room air. You are concerned about securing his airway, given his facial anomalies. What equipment should be kept at the bedside in case this progresses to respiratory failure? Is there a backup airway device that should be readily available? Should an advanced airway team be called?
For the 4-year-old boy with Pierre Robin sequence and influenza A infection, rapid sequence ETI was attempted due to impending respiratory failure. The procedure was unsuccessful due to difficulty visualizing the vocal cords. A cLMA was on-hand as a backup airway, and it was successfully placed on the first attempt. Oxygenation and ventilation were maintained via the SGA. The patient was admitted to the pediatric intensive care unit. The SGA was changed to an ETT by pediatric anesthesia, and the patient was weaned off respiratory support in 48 hours. He recovered fully and was discharged home soon after.