Paediatric Acute care Guidelines PMH Emergency Department

General

  • Airway adjuncts refer to oropharyngeal and nasopharyngeal airways
  • These can aid in airway patency

Indications

  • Upper airway obstruction

Equipment

Oropharyngeal Airways:

  • Also called Guedel airway
  • Used in unconscious patients (not tolerated if awake due to gag reflex)
  • Creates a channel between the tongue and the posterior pharynx
  • There are a number of sizes – to estimate the correct size place the airway on the child’s face. The correct size will fit between the centre of the incisors to the angle of the mandible
  • Insertion: use a laryngoscope blade or tongue depressor to depress the tongue and aid insertion. Insert the right way up = concave down (do not twist like in adults – this can cause mucosal damage and haemorrhage) until the hub is sitting at the lips

Nasopharyngeal Airways:

  • Contraindicated in head injury and base of skull fractures
  • These can be tolerated in the awake patient
  • Measure the appropriate length from the lateral edge of the nostril to the tragus of the ear
  • Ensure the diameter is smaller than the patient’s nostril
  • May cause haemorrhage from muscosal trauma
  • If these are not available, you can cut an ETT to the appropriate length and use instead
  • Insertion: put a small amount of lubricant on the end of the tube, insert the tip into the nostril and direct the tube along the floor of the nose (not upwards) until the flange rests on the nostril. You can use a gentle twist to aid insertion.

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