In this peds airway pearls segment, we’ll walk through a case of a nine year old in status epilepticus. She’s hypoxic and you need to optimize pre-oxygenation and ultimately intubate her in the ED. Dr. Runkle gives her peds airway pearls as we walk through the case!

Guest: Anne Runkle, MD. Host: Lizzy Hellmann, MD and Kim Bambach, MD. Editor: Kim Bambach, MD and Ben Ostro, MD.

Key Take-Aways:

1. Optimize pre-oxygenation for this patient: look at positioning (ear to sternal notch), bagging technique, use airway adjuncts, suctioning, elevating the head of the bed. A PEEP valve on your BVM or temporary NIPPV are additional options.





2. Choose the right blade: “Mac 3 in 3rd grade”. If the patient is 8 years old or 30 kilos, consider starting with a Mac 3 because the longer blade will help you reach the vollecula and you could also use the Mac blade as a Miller and lift the epiglottis. iI the 8-10 year old range you are at a transition point from pediatric to adult airway anatomy.





3. Have multiple tube sizes (one size smaller) prepped and ready: remember cuffed ETT size is 3.5 + age/4. Having a smaller tube available will help if there are copious secretions (which is likely if the patient is seizing) or edema.





4. Have an LMA available: this may help with bagging the patient if you need a second attempt. i-Gel supraglottic airways have a suction port that can be used with a suction catheter (but be mindful that the pt cannot be bagged simultaneously and active vomiting is a contraindication to LMA).





5. RSI med choice: Ketamine is the ideal sedative choice in this case, as propofol is difficult to obtain in pediatric EDs.