Regarding Ed Frieberg's insistance that you simply must intubate the trachea
every time, this expectation is unrealistic. His comments also imply that all
prehospital EMS personnel should be able to do this -- no excuses. Well, in the
real world, training in pediatric airway management is extremely limited. If
the trainee is fortunate enough to receive this, he is rarely called upon to
practice it and his minimal skills are quickly lost. No one in EM intubates
infants every day and some do it maybe once or twice a year.
Knowledge of the theory of pediatric intubation is key as is ability in
ventilating the unintubated airway. This would include intermittent gastric
decompression. Intermittent feline intubation, in my opinion, represents a tiny
step toward proficiency.
I would encourage EM personnel to continue to get as much continuing education
as they can, to try to think clearly in critical situations, and to discuss
tough pediatric resuscitations with supervisors and medical directors with more
J. A. Greenberg, M.D.
Dept. of Anesth. - Children's Hospital of Pittsburgh