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| ==General considerations==
| | #REDIRECT[[Intubation (peds)]] |
| *Anatomical differences of neonates (compared to adults/big kids):
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| **Large occiput--> may need shoulder roll to get ear to sternal notch aligned
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| **Relatively larger tongue, small mouth
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| **More anterior larynx
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| **Larger/floppier epiglottis
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| **Short trachea--> easy to mainstem tube, easy for accidental tube dislodgement
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| *Cuffed vs uncuffed ETT: controversial<ref>https://pedemmorsels.com/cuffed-endotracheal-tubes-in-children/</ref> but cuffed tubes now genearlly considered acceptable<ref>American Heart Association. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, Vol. 122, Issue 18, Suppl 3; Novemeber 2, 2010.</ref>
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| ==Equipment/sizes/numbers==
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| *ETT tube size:
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| **Full term newborn - 3.5-4 uncuffed
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| **Preemie- gestational age in weeks/10 (e.g. 24-25wker gets a 2.5)
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| *Blade:
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| **Preemie <1.5kg: 00
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| **Full term newborn: 0
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| **Neonate/infant: 1
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| *ETT depth
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| **Newborn/neonate: uncuffed ETT x 3 (cm at lip)
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| **Preemie: weight in kg +1 (cm at lip)
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| *LMA size
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| **Weight in kg/20 + 1
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| *Apneic O2 by NC for newborn/neonate: 5L/m
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| *Routine vent settings
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| **FiO2 100%--> wean
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| **PEEP 4-5
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| **TV 8-10cc/kg
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| **RR 25-35
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| **I-time 0.5s
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| ==Drugs==
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| *[[Atropine]] premedication
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| **Controversial
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| **Neonates VERY prone to [[PALS: Bradycardia|bradycardia]] with myriad stimuli, including the vagal stimulation of laryngoscopy
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| **May not be needed routinely but should at least have handy in case of bradycardia<ref>https://pedemmorsels.com/atropine-needed-rsi/</ref>
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| **0.01-0.03 mg/kg IV/IO
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| *Sedation
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| **[[Ketamine]] ''not'' approved for <3mo <ref>https://reference.medscape.com/drug/ketalar-ketamine-343099</ref>
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| **[[Fentanyl]] 1mcg/kg
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| **[[Etomidate]] 0.3mg/kg
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| *[[Neuromuscular blocking agents|Paralytic]]- consider double dose in shock
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| **[[Rocuronium]] 1.2mg/kg
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| ***Preferred as may not yet be aware of preexisting conditions that would make sux contraindicated
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| **[[Succinylcholine]] 1.5mg/kg
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| ==See Also==
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| *[[Neonatal resuscitation]], [[newborn resuscitation]]
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| *[[Pediatric jet ventilation]]
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| *[[The difficult airway]]
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| ==External Links==
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| ==References==
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| <references/>
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| [[Category:Procedures]]
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| [[Category:Pediatrics]]
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| [[Category:Critical Care]]
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