Neonatal RSI - Revision history

Rossdonaldson1: Changed redirect target from Neonatal intubation to Intubation (peds)

2020-07-13T06:08:55Z

Changed redirect target from Neonatal intubation to Intubation (peds)

← Older revision		Revision as of 06:08, 13 July 2020
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	#REDIRECT[[~~Neonatal intubation~~]]		#REDIRECT[[Intubation (peds)]]

ClaireLewis: Redirected page to Neonatal intubation

2019-08-29T16:35:50Z

Redirected page to Neonatal intubation

← Older revision		Revision as of 16:35, 29 August 2019
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	~~==General considerations==~~		#REDIRECT[[Neonatal intubation]]
	*Anatomical differences of neonates (compared to adults/big kids):
	**Large occiput--> may need shoulder roll to get ear to sternal notch aligned
	**Relatively larger tongue, small mouth
	**More anterior larynx
	**Larger/floppier epiglottis
	**Short trachea--> easy to mainstem tube, easy for accidental tube dislodgement

	*Cuffed vs uncuffed ETT: controversial<ref>https://pedemmorsels.com/cuffed-endotracheal-tubes-in-children/</ref> but cuffed tubes now genearlly considered acceptable<ref>American Heart Association. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, Vol. 122, Issue 18, Suppl 3; Novemeber 2, 2010.</ref>

	~~==Equipment/sizes/numbers==~~
	*ETT tube size:
	**Full term newborn - 3.5-4 uncuffed
	**Preemie- gestational age in weeks/10 (e.g. 24-25wker gets a 2.5)
	*Blade:
	**Preemie <1.5kg: 00
	**Full term newborn: 0
	**Neonate/infant: 1
	*ETT depth
	**Newborn/neonate: uncuffed ETT x 3 (cm at lip)
	**Preemie: weight in kg +1 (cm at lip)
	*LMA size
	**Weight in kg/20 + 1
	*Apneic O2 by NC for newborn/neonate: 5L/m
	*Routine vent settings
	**FiO2 100%--> wean
	**PEEP 4-5
	**TV 8-10cc/kg
	**RR 25-35
	**I-time 0.5s

	~~==Drugs==~~
	*[[Atropine]] premedication
	**Controversial
	**Neonates VERY prone to bradycardia with myriad stimuli, including the vagal stimulation of laryngoscopy
	**May not be needed routinely but should at least have handy in case of bradycardia<ref>https://pedemmorsels.com/atropine-needed-rsi/</ref>
	**0.01-0.03 mg/kg IV/IO

	*Sedation
	**[[Ketamine]] ''not'' approved for <3mo <ref>https://reference.medscape.com/drug/ketalar-ketamine-343099</ref>
	**[[Fentanyl]] 1mcg/kg
	**[[Etomidate]] 0.3mg/kg
	*Paralytic- consider double dose in shock
	**[[Rocuronium]] 1.2mg/kg
	***Preferred as may not yet be aware of preexisting conditions that would make sux contraindicated
	**[[Succinylcholine]] 1.5mg/kg

	~~==See Also==~~
	*[[Neonatal ~~resuscitation]], [[newborn resuscitation]]~~
	*[[Pediatric jet ventilation]]
	*[[The difficult airway]]

	~~==External Links==~~


	~~==References==~~
	~~<references/>~~

	~~[[Category:Procedures]]~~
	~~[[Category:Pediatrics]]~~
	~~[[Category:Critical Care~~]]

ClaireLewis: Created page with "==General considerations== *Anatomical differences of neonates (compared to adults/big kids): Large occiput--> may need shoulder roll to get ear to sternal notch aligned R..."

2019-08-29T16:34:44Z

Created page with "==General considerations== *Anatomical differences of neonates (compared to adults/big kids): **Large occiput--> may need shoulder roll to get ear to sternal notch aligned **R..."

New page

==General considerations==
*Anatomical differences of neonates (compared to adults/big kids):
**Large occiput--> may need shoulder roll to get ear to sternal notch aligned
**Relatively larger tongue, small mouth
**More anterior larynx
**Larger/floppier epiglottis
**Short trachea--> easy to mainstem tube, easy for accidental tube dislodgement

*Cuffed vs uncuffed ETT: controversial<ref>https://pedemmorsels.com/cuffed-endotracheal-tubes-in-children/</ref> but cuffed tubes now genearlly considered acceptable<ref>American Heart Association. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, Vol. 122, Issue 18, Suppl 3; Novemeber 2, 2010.</ref>

==Equipment/sizes/numbers==
*ETT tube size:
**Full term newborn - 3.5-4 uncuffed
**Preemie- gestational age in weeks/10 (e.g. 24-25wker gets a 2.5)
*Blade:
**Preemie <1.5kg: 00
**Full term newborn: 0
**Neonate/infant: 1
*ETT depth
**Newborn/neonate: uncuffed ETT x 3 (cm at lip)
**Preemie: weight in kg +1 (cm at lip)
*LMA size
**Weight in kg/20 + 1
*Apneic O2 by NC for newborn/neonate: 5L/m
*Routine vent settings
**FiO2 100%--> wean
**PEEP 4-5
**TV 8-10cc/kg
**RR 25-35
**I-time 0.5s

==Drugs==
*[[Atropine]] premedication
**Controversial
**Neonates VERY prone to bradycardia with myriad stimuli, including the vagal stimulation of laryngoscopy
**May not be needed routinely but should at least have handy in case of bradycardia<ref>https://pedemmorsels.com/atropine-needed-rsi/</ref>
**0.01-0.03 mg/kg IV/IO

*Sedation
**[[Ketamine]] ''not'' approved for <3mo <ref>https://reference.medscape.com/drug/ketalar-ketamine-343099</ref>
**[[Fentanyl]] 1mcg/kg
**[[Etomidate]] 0.3mg/kg
*Paralytic- consider double dose in shock
**[[Rocuronium]] 1.2mg/kg
***Preferred as may not yet be aware of preexisting conditions that would make sux contraindicated
**[[Succinylcholine]] 1.5mg/kg

==See Also==
*[[Neonatal resuscitation]], [[newborn resuscitation]]
*[[Pediatric jet ventilation]]
*[[The difficult airway]]

==External Links==

==References==
<references/>

[[Category:Procedures]]
[[Category:Pediatrics]]
[[Category:Critical Care]]

Neonatal RSI - Revision history

Rossdonaldson1: Changed redirect target from Neonatal intubation to Intubation (peds)

ClaireLewis: Redirected page to Neonatal intubation

ClaireLewis: Created page with "==General considerations== *Anatomical differences of neonates (compared to adults/big kids): **Large occiput--> may need shoulder roll to get ear to sternal notch aligned **R..."

ClaireLewis: Created page with "==General considerations== *Anatomical differences of neonates (compared to adults/big kids): Large occiput--> may need shoulder roll to get ear to sternal notch aligned R..."