Publication Date: October 2020 (Volume 17, Number 10)
CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 10/01/2023.
Endotracheal intubation can be difficult in the emergent situation, and it is important to have an appropriate backup strategy. Supraglottic airway devices have provided an alternative method for pediatric airway management that is relatively easy to learn, with a high success rate. This issue reviews the use of supraglottic airway devices in pediatric patients including common devices, indications and techniques for placement, and complications associated with their use. The use of supraglottic airway devices in the patient with a difficult airway is also discussed.
Excerpt From This Issue
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?
During your next shift in the ED, you are caring for a 15-year-old boy with a traumatic elbow dislocation that occurred while he was playing soccer. The orthopedic surgeon on call would like to reduce the dislocation in the ED using procedural sedation. The patient recovered from an upper respiratory tract infection a couple of days ago, and you are concerned about possible airway complications. Does the recent upper respiratory tract infection increase the risk for possible airway compromise? Should this procedure be attempted without sedation?