Advanced Trauma Life Support ATLS Student Course Manual 2018

AIRWAY 193
tube size. For example, a 4.0 ETT would be properly
positioned at 12 cm from the gums.
Management
In a spontaneously breathing child with a partially
obstructed airway, optimize the airway by keeping the
plane of the face parallel to the plane of the stretcher
or gurney while restricting motion of the cervical
spine. Use the jaw-thrust maneuver combined with
bimanual inline spinal motion restriction to open the
airway. After the mouth and oropharynx are cleared of
secretions and debris, administer supplemental oxygen.
If the patient is unconscious, mechanical methods
of maintaining the airway may be necessary. Before
attempting to mechanically establish an airway, fully
preoxygenate the child.
Oral Airway
An oral airway should be inserted only if a child is
unconscious, because vomiting is likely to occur
if the gag reflex is intact. The practice of inserting
the airway backward and rotating it 180 degrees
is not recommended for children, since trauma
and hemorrhage into soft-tissue structures of the
oropharynx may occur. Insert the oral airway gently
and directly into the oropharynx. Using a tongue blade
to depress the tongue may be helpful.
Orotracheal Intubation
(See Infant Endotracheal Intubation video on MyATLS
mobile app.) However, the use of cuffed ETTs, even in
toddlers and small children, provides the benefit of
improving ventilation and CO 2
management, resulting
in improved cerebral blood flow. Previous concerns
about cuffed endotracheal tubes causing tracheal
necrosis are no longer relevant due to improvements
in the design of the cuffs. Ideally, cuff pressure should
be measured as soon as is feasible, and