Advanced Trauma Life Support ATLS Student Course Manual 2018

192
CHAPTER 10 n Pediatric Trauma
A
B
n FIGURE 10-1 Resuscitation Tape. A. A length-based resuscitation tape, such as the Broselow® Pediatric Emergency Tape, is an ideal
adjunct to rapidly determine weight based on length for appropriate fluid volumes, drug doses, and equipment size. B. Detail, showing
recommended drug doses and equipment needs for pediatric patients based on length.
cause of cardiac arrest in children. Therefore, the
child’s airway is the first priority. (Also see Chapter 2:
Airway and Ventilatory Management, and Appendix G:
Airway Skills.)
Plane of face is not
parallel to spine board
Anatomy
The smaller the child, the greater is the disproportion
between the size of the cranium and the midface. The
large occiput results in passive flexion of the cervical
spine, leading to a propensity for the posterior pharynx
to buckle anteriorly. To avoid passive flexion of the
cervical spine, ensure that the plane of the midface
is maintained parallel to the spine board in a neutral
position, rather than in the “sniffing position” (n FIGURE
10-2A). Placement of a 1-inch layer of padding beneath
the infant or toddler’s entire torso will preserve neutral
alignment of the spinal column (n FIGURE 10-2B).
Several anatomical features of children affect airway
assessment and management. The soft tissues of an
infant’s oropharynx (i.e., the tongue and tonsils) are
relatively large compared with the tissues in the oral
cavity, which may compromise visualization of the
larynx. A child’s larynx is funnel shaped, allowing
secretions to accumulate in the retropharyngeal area.
The larynx and vocal cords are more cephalad and
anterior in the neck. The vocal cords are frequently
more difficult to visualize when the child’s head is in the
normal, supine, anatomical position during intubation
than when it is in the neutral position required for
optimal cervical spine protection.
An infant’s trachea is approximately 5 cm long and
grows to 7 cm by about 18 months. Failure to appreciate
this short length can result in intubation of the right
A
B
Plane of face is
parallel to spine board
n FIGURE 10-2 Positioning for Airway Maintenance. A. Improper
positioning of a child to maintain a patent airway. The disproportion
between the size of the child’s cranium and midface leads to a
propensity for the posterior pharynx to buckle anteriorly. The
large occiput causes passive flexion of the cervical spine. B. Proper
positioning of a child to maintain a patent airway. Avoid passive
flexion of the cervical spine by keeping the plane of the midface
parallel to the spine board in a neutral position, rather than in the
“sniffing position.” Placement of a 1-inch layer of padding beneath
the infant’s or toddler’s entire torso will preserve neutral alignment
of the spinal column.
mainstem bronchus, inadequate ventilation, accidental
tube dislodgment, and/or mechanical barotrauma. The
optimal endotracheal tube (ETT) depth (in centimeters)
can be calculated as three times the appropriate
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