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Chapter 3: Resuscitation of Children and Neonates

Marc F. Collin

INTRODUCTION

Children primarily develop cardiac arrest secondary to hypoxia from respiratory arrest or shock syndromes. Because of age and size differences among children, equipment sizes also differ (Table 3-1).

Table 3-1

Length-Based Equipment Chart (Length = Centimeters)∗

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Table 3-1

Length-Based Equipment Chart (Length = Centimeters)∗
Item 54–70 70–85 85–95 95–107 107–124 124–138 138–155
Endotracheal tube size (mm) 3.5 4.0 4.5 5.0 5.5 6.0 6.5
Lip–tip length (mm) 10.5 12.0 13.5 15.0 16.5 18.0 19.5
Laryngoscope 1 straight 1 straight 2 straight 2 straight or curved 2 straight or curved 2–3 straight or curved 3 straight or curved
Suction catheter 8F 8F–10F 10F 10F 10F 10F 12F
Stylet 6F 6F 6F 6F 14F 14F 14F
Oral airway Infant/small child Small child Child Child Child/small adult Child/adult Medium adult
Bag-valve mask nfant Child Child Child Child Child/adult Adult
Oxygen mask Newborn Pediatric Pediatric Pediatric Pediatric Adult Adult
Vascular access (gauge)
Catheter 22–24 20–22 18–22 18–22 18–20 18–20 16–20
Butterfly 23–25 23–25 21–23 21–23 21–23 21–22 18–21
Nasogastric tube 5F–8F 8F–10F 10F 10F–12F 12F–14F 14F–18F 18F
Urinary catheter 5F–8F 8F–10F 10F 10F–12F 10F–12F 12F 12F
Chest tube 10F–12F 16F–20F 20F–24F 20F–24F 24F–32F 28F–32F 32F–40F
Blood pressure cuff Newborn/infant Infant/child Child Child Child Child/adult Adult

Directions for use: (1) measure patient length with centimeter tape; (2) using measured length in centimeters, access appropriate equipment column.

PEDIATRIC CARDIOPULMONARY RESUSCITATION

Securing the Airway

The airway in infants and children is smaller, variable in size, and higher and more anterior than that in the adult. The prominent occiput and relatively large tongue and epiglottis may lead to obstruction when the child is in the supine position.

Mild extension of the neck in the sniffing position opens the airway. This may be maintained by placing a towel beneath the shoulders. Chin lift or jaw thrust maneuvers may relieve obstruction of the airway related to the tongue. Oral airways are not commonly used in pediatrics but may be useful in the unconscious child who requires continuous jaw thrust or chin lift to maintain airway patency. Oral airways are inserted by direct visualization with a tongue blade.

A bag-valve-mask system is commonly used for ventilation. Minimum volume for ventilation bags for infants and children is 450 mL. The tidal volume necessary to ventilate children is 8 to 10 mL/kg. Observation of chest rise and auscultation of breath sounds will ensure adequate ventilation.

Endotracheal intubation usually is performed with a Miller straight blade with a properly sized tube. Resuscitation measuring tapes have been found to be the most accurate for determining tube size. The formula 16 plus age in years divided by 4 calculates approximate tube size. Uncuffed tubes are commonly used in children up to 8 years, but cuffed tubes can be used in ...

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