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Original Question

Case Study 1 A 5-year-old boy presented to the emergency department with signs of acute airway obstruction and stridor. The signs and symptoms had begun the day before, with a respiratory infection, and had quickly progressed. His mother reported that the child ate peanuts as well. On arrival, the boy was restless and agitated, with dyspnea and tachypnea. He was sitting in a tripod position, and audible inspiratory stridor in the head-up position was noted. Cyanosis was present and his oxygen saturation by pulse oximetry was 85%. His vital signs upon admission were as follows: temperature 37.8°C, blood pressure 90/60 mm Hg, heart rate 160 beats per minute, respiratory rate 38 breaths per minute. The chest examination revealed decreased aeration bilaterally, transmitted sounds from the upper airway, and wheezing and whispery sounds. Systemic corticosteroids and 100% oxygen by face mask were given immediately. The physician asks you to prepare for intubation to assure an airway is secured . 1. What size and type of ETT will you prepare for this patient? 2. What mnemonic is used as a checklist memory aid for equipment essential for endotracheal intubation? The child was successfully intubated and transferred to the ICU. 3. Is there another method the physician may have chosen because of the upper airway obstruction and associated risks? Case Study 2 A 10-month-old girl was transported to the emergency department by paramedics. She has a history of fever and had a seizure at home. On arrival, the patient was not actively seizing, but she was apenic with an oxygen saturation of 75%. You position the head, open the airway, and, using the EC-clamp technique, you provide oxygen by a bag-valve-mask resuscitator. You suction the airway to remove oral secretions. At this time, the physician takes over manual ventilation and asks you to prepare for intubation. He would like an oral airway, with appropriate ETT size, stylet, and laryngoscope handle and blades. Using SOAPPIM, you prepare for intubation. 1. What size ETT, oral airway, stylet, and laryngoscope blades will you prepare for this patient? The patient is intubated without any adverse intubation-associated events. 2. How do you confirm endotracheal tube placement in the pediatric patient? 3. What other intubation device could have been used for this patient?

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