A 4-year-old boy is in severe respiratory distress after a motor vehicle crash. He was ejected from the vehicle and has major facial and head trauma. When managing his airway, you should:
Use an appropriately sized laryngeal mask airway to limit the likelihood of aspiration.
+Perform a needle cricothyrotomy rather than a formal surgical cricothyrotomy if you cannot intubate or ventilate.
+Extend the neck to improve visualization of the airway structures.
+Attempt blind nasotracheal intubation with an appropriate size endotracheal tube.
+Avoid succinylcholine because of the acute trauma.
Laryngeal mask airways may be used as a rescue device in this age, but they do not protect against aspiration of stomach contents. Needle cricothyrotomy is preferred over formal surgical cricothyrotomy in young children because of the size of the small cricothyroid membrane. The tracheal opening is located more anterior and superior than in adults. In this case, hyperextension of the neck is contraindicated because of the potential for cervical spine injury after trauma. Blind nasotracheal intubation is not performed in young children, especially in patients after head and facial trauma. Succinylcholine is not contraindicated in acute trauma.