T - There is little as frightening than being put in a position to manage
the airway of a small, unconscious child. I am a pediatric anesthesiologist
who does this every day, but I never take being able to do this for granted.
Fortunately, I have the luxury of practicing in a well-equipped operating
room. I train paramedic students from a number of programs in Western Penna.
A couple of thoughts: 1. Get some suction catheters on your ambulance.
They're inexpensive and will deflate the stomach even if you don't have a
negative pressure suction apparatus such as a Gomco. 2. Get a portable
suction apparatus; this is really important for effective airway
management. 3. Like you and your medical director, I am petrified of ever
having to perform a cric in a young child. I believe in my heart of hearts
that this is too dangerous to consider as a life-saving measure because the
anatomy (esp. the trachea) is small and difficult to identify. Most children
with isolated pulmonary aspiration of gastric contents do survive, all other
things being equal (i.e., no cardiac arrest, no SIDS, no drowning, etc). I
cannot quote any statistics for infants who have had complications from a
cric performed by inexperienced personnel.
I agree that intubation is best. Also, insertion of a laryngeal mask airway
may work in many situations.
Good luck with your future plans! - J
>I have some reservations relying heavily on BLS airway management of the
>peds patient in arrest or near arrest. We as paramedics go through
>extensive training which empahsizes assessment over and over and over -
>especially with the peds patient. Because of this, hopefully an errant
>espohageal intubation can be detected and corrected. One of the biggest
>problems in managing a cardiac arrest - or any patient that a BLS
>procedure is being used to ventilate the patient is gastric distention.
>Prehospitally - we don't have NG tubes and consequently end up with high
>risk for aspiration and airway occlustion b/c of emesis. No matter how
>careful one ventilates with a BVM - the patient will eventually vomit.
>Intubation is the way to go - it's a sure-thing - provided it is
>constantly maintained. This brings up another problem - in infants and
>newborns the tube can become dislodged very easily. - Once again -
>constant assesment - including ETCO2 and SaO2 can aid in detecting this
>Actually what brought up the peds cric question: a group of us
>"squirrells" were discussing anaphalaxis and eppiglotitis in rural
>settings - and the long response times involved for EMS. The question
>came up about kids and what to do. Our Medical Director, Dr. Ed Racht
>told us that he wouldn't have a problem with our using the cric - but we
>had better have exhausted every possible means of ventillating the
>patient. Goal #1 is airway. I just hope and pray that I never have to
>do it - or that if I am ever in that situation - my partner drives really
>fast so that those of you, whose ranks I aspire to join (M.D.'s) can
>manage the patient.
>Tom Hesbach, NREMTP
>Forest View Volunteer Rescue Squad
James A. Greenberg, M.D. <[log in to unmask]>
Department of Anesthesiology - 7469 DeSoto Wing
Children's Hospital of Pittsburgh - 3705 Fifth Avenue
Pittsburgh, PA 15213
Voice: (412) 692-6394 Fax: (412) 692-8658