Tracheal Intubation –Pediatric Protocol

The pediatric airway is particularly challenging due to the small patient size, differences in anatomy, and relatively high oxygen demand in pediatric patients. In addition, respiratory compromise is the most common antecedent event prior to a cardiorespiratory arrest. Prompt, proper management of the airway is essential in management of a critically ill pediatric patient.

Indications
1. Unconscious patient with no gag reflex requiring airway protection.

Suggested Tracheal Tube Sizes and Depth
Procedure
1. Perform patient assessment and record vital signs, level of consciousness, and
oxygen saturation.
2. Assess that patient meets criteria for this protocol.
3. Ensure there are no contraindications to use of this protocol.
4. Initiate basic life support treatment measures, including supplemental oxygen.
- these take precedence over management using this protocol
5. Ensure cervical spine immobilization is in place, if indicated.
6. Preoxygenate and ventilate with 100% O2 using bag-valve mask.
7. Second EMT applies cricoid pressure.
8. Airway is visualized directly using laryngoscope, following accepted procedure.
• do not rock or lever the laryngoscope on the patient’s teeth
9. When vocal cords have been visualized, pass tracheal tube through the cords.
10. Inflate tracheal tube cuff if using a cuffed tube.
11. Begin ventilation and confirm tube placement following accepted procedure.
• confirmation of tube placement must include end-tidal CO2 detection
• ensure the end-tidal CO2 detection device used is age- or weight-appropriate
12. Release cricoid pressure.
13. Secure tracheal tube. Do not cut tracheal tube.
14. Insert an oral airway or suitable alternative.
15. Initiate transport, unless other emergency condition requires immediate treatment.

Notes:
- Each attempt at intubation should be limited to thirty (30) seconds, with adequate oxygenation and ventilation between attempts.
- A maximum of two (2) attempts at tracheal intubation is permitted.
- Tracheal tube position must be checked frequently, and after any transfer or movement of the patient, because tube displacement occurs easily in pediatric patients.