Intubation Essentials-- Part 1 Preparation and Checklists

About our guests:
Dr. Alyssa Stoner is an Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine and practicing pediatric intensivist at Children's Mercy Kansas City.
Dr. Gina Patel is a fellow in pediatric critical care at Children's Mercy Kansas City.

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Objectives

• The participant will be able to compile a complete list of equipment necessary to perform a pediatric intubation, with acknowledgment of mnemonic.
• The participant will be able to determine the appropriate size and depth of insertion of endotracheal tube based on patient’s age utilizing a common estimation formulas.
• The participant will be able to describe the appropriate patient set up; including positioning for a successful intubation.

When a checklist is elusive a simple mnemonic can be helpful to recall the necessary equipment:

Mnemonic: SOAP ME

Suction Device: Ensure suction is turned on and at appropriate level

• Yaunker or large bore suction tube 14 French
• Consider second suction set up especially if concerned about pulmonary hemorrhage or pulmonary edema

Oxygen Delivery system: ensure oxygen sources is connected and functioning appropriately

• Nasal Cannula vs. High Flow/ Non-Rebreather
• Consider non-Invasive if poor oxygenation
• Consider need for apneic oxygenation depending on clinical situation
• Self-inflating anesthesia bag with appropriately sized mask

Airway Equipment:

• Direct Laryngoscope: Blade type and size considerations
• Video Laryngoscope: CMAC or Glidescope dependent upon access and comfort
• Endotracheal tube: Correct size + size down
• Back up airway IE: Laryngeal Mask Airway (LMA)

Patient Position: Most of procedural success is based upon the appropriate patient positioning

• Consider age of patient and position accordingly to achieve appropriate sniffing position, consider utilizing small shoulder roll (in patients <2years of age) or a small pillow for adolescents/adult sized patients to align all three axis (Oral axis, laryngeal axis and pharyngeal axis) to allow for best view

Medication plan: specific to patient and clinical scenario, there are many combinations that can be utilized and some for specific scenarios.

• Analgesic agent: ie: Fentanyl
• Amnestic agent: ie: Versed
• Paralytic agent: ie: Rocuronium

Equipment: ensure all monitors placed appropriately (BP cuff and pulse ox on separate extremities)

• BP monitoring (art line or non-invasive)
• Pulse ox
• Telemetry leads
• Capnography/End tidal (attached to monitor/ventilator, calorimetry)
• Ventilator

Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for informational and educational purposes only. It should not be used as a replacement for medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates

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