Airway Management (Pediatric)

EMT STANDING ORDERS: -

• Routine Patient Care.
• Establish airway patency.
  • Open and maintain the airway.
  • Suctioning as needed.
  • Clear foreign body obstructions.
  • Consider inserting an oropharyngeal or nasopharyngeal airway adjunct.
  • Consider inserting a Supraglotic Airway (LMA)
• Administer oxygen as appropriate with a target of achieving 94 - 98% saturation.
• If patient has a tracheostomy tube, see Tracheostomy Care Procedure - Adult & Pediatric (28 Skills).
• For respiratory distress:
  • Administer high concentration oxygen (preferably humidified) via mask positioned on face or if child resists, held near face.
  • Administer oxygen as appropriate with a target of achieving 94 – 98%.
  • For children with chronic lung disease or congenital heart disease, ask caregivers about patient’s history, including home oxygen level or patient’s target oxygen saturation. Maintain target saturation, and contact Medical Direction to discuss oxygenation and appropriate transport destination.
  Note: Pulse oximetry is difficult to obtain in children. Do not rely exclusively on pulse oximetry. If child continues to exhibit signs of respiratory distress despite high oxygen saturation levels, continue oxygen administration. For respiratory failure or for distress that does not improve with oxygen administration
  • Assist ventilations with BVM at rate appropriate for child’s age. Reference Pediatric Color Coded Appendix (Appendix 1).
  • If unable to maintain an open airway through positioning, consider placing an oropharyngeal or nasopharyngeal airway.
• Determine if child's respiratory distress/failure is caused by a preexisting condition
  • For Allergic Reaction/Anaphylaxis, refer to the Allergic Reaction/Anaphylaxis Protocol-Pediatric (29 Medical).
  • For Asthma/Reactive Airway Disease/Croup, refer to the Asthma/Bronchiolitis/RAD/ Croup Protocol – Pediatric (1 Medical).

ADVANCED EMT STANDING ORDERS:

• For respiratory distress, consider CPAP.
• For respiratory failure, use the most appropriate/least invasive method.
• BVM ventilation is the preferred method of ventilation for the pediatric population. However, if unsuccessful, consider the placement of a supraglottic airway.
  • In cardiac arrest: consider insertion of a supraglottic airway. See Supraglottic Airway Procedure - Adult & Pediatric (6 Skills).

PARAMEDIC STANDING ORDERS:

• Consider high-flow nasal canula if appropriate administration system is available.
• Consider an advanced airway if airway cannot be maintained through positioning.
• Prolonged transport time alone should not warrant more invasive interventions.
• Orotracheal Intubation Procedure (8 Skills) or Supraglottic Airway Procedure - Adult & Pediatric (6 Skills).
• If feasible, place an orogastric tube to decompress stomach.

  RESPIRATORY DISTRESS:	RESPIRATORY FAILURE:
  Alert, irritable, anxious.	Sleepy, intermittently combative or agitated.
  Stridor	Respiratory rate < 10 breaths per minute.
  Audible wheezing/grunting.	Absent or shallow respirations with poor air movement.
  Respiratory rate outside normal range for child’s age.	Severe intercostal retractions.
  Sniffing position.	Paradoxical breathing.
  Nasal flaring.	Limp muscle tone.
  Head bobbing.	Inability to sit up.
  Neck muscle use.	Cyanosis and/or mottled skin.
  Intercostal retractions.	Bradycardia.
  Central cyanosis that resolves with oxygen administration.
  Mild tachycardia.