Intubation - emergency intubation in PICU/CED

Emergency intubation in PICU/CED

1. Immediately call for help and resuscitation trolley/airway trolley.

2. Ensure senior support notified

   1. In PICU - contact PICU Consultant/Fellow

   2. In ED - contact on call CED Consultant/Fellow and notify PICU.

3. Give 100% oxygen and assist ventilation with bag and mask if necessary.

High risk patient asessment: if ANY of the following present delay intubation, if possible, until senior help is present

1. Airway

   1. History of known difficult airway

   2. Any of the following: small mouth, small jaw, large tongue, short neck, signs of airway obstruction, or trauma or swelling to the face or neck

2. Clinical Status

   1. Unstable haemodynamics

   2. < 1 yr

   3. Failed non-invasive ventilation

   4. Morbidly obese

   5. C-spine precautions

Airway - Intubator and/or Airway Assistant

1	Optimise patient position (ear-sternal notch alignment)
2	Working suction / Yankauer sucker
3	Face mask and Guedal airway of correct size, and bagging system
4	Three endotracheal tubes (age appropriate + ½ size and syringe for cuff a. Uncuffed = Age/4 +4, Cuffed (balloon checked and deflated) = Age/4 +3.5 b. 3.5 for term neonates
5	Two working laryngoscopes + video laryngoscope
6	Bougie – age appropriate
7	Laryngeal mask of correct size
8	Personal protection – mask and gloves

 

Bedside/Circulation Nurse

1	Monitoring attached a. ECG b. NIBP (cycling q 2min) or arterial line c. SpO2 (not on same limb as BP cuff) d. ETCO2 – calibrated or ETCO2 colour change detector
2	Functioning vascular access - flushed

Medication Nurse

Discuss required medications with event manager

1	Emergency medication sheet printed
2	IV fluid for volume expansion
3	Intubation medications
4	Adrenaline (drawn up if high risk patient) + other resuscitation medications

 

Event manager to announce and confirm the plan with the team

1. Personnel: Intubator, assistant, medication giver, timer and documentation

2. Plan A, Plan B

3. “Does anyone have any concerns?”