Children primarily develop cardiac arrest secondary to hypoxia from respiratory arrest or shock syndromes. Because of age and size differences among children, drug dosages, compression and respiratory rates, and equipment sizes differ considerably (Table 3-1).
Table 3-1 Length-Based Equipment Chart (Length = Centimeters)* ||Download (.pdf)
Table 3-1 Length-Based Equipment Chart (Length = Centimeters)*
|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|
|Oral airway||Infant/small child||Small child||Child||Child||Child/small adult||Child/adult||Medium adult|
|Vascular access (gauge)|
|Blood pressure cuff||Newborn/infant||Infant/child||Child||Child||Child||Child/adult||Adult|
The airway in infants and children is smaller, variable in size, 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 head in the sniffing position opens the airway. 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 10 to 15 mL/kilogram. 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 used in children up to 8 years.
Initiate ventilation at 20 breaths/min for infants, 15 breaths/min for young children, and 10 breaths/min for adolescents unless hyperventilation is required.