Paediatric Acute care Guidelines PMH Emergency Department

Pre-Procedure

  • Always have a spare laryngoscope and spare batteries

General

  • Laryngoscopes are used in endotracheal intubation
  • Always check your equipment carefully before attempting to intubate

Equipment

  • Laryngoscopes consist of two parts – the handle (with batteries inside) and the blade
  • Always have at least two laryngoscopes and some spare batteries – in case the globe is not working or the batteries are flat

Blades:

  • There are two types of laryngoscope blades: straight and curved
  • Straight (Miller) blades are used in neonates and infants. They are designed for the tip to fit beneath the epiglottis and directly lift it forward. They come in two sizes – 0 and 1. They can cause vagal stimulation, bradycardia and laryngospasm.
  • Curved (MacIntosh) blades are used in chidren. The technique is the same as for adults – the tip of the blade should sit in the valeculla anterior to the epiglottis and lift it forward. They come in 3 paediatric sizes – 1, 2 and 3.
  • The appropriate blade length can be sized by measuring between the central incisors and the angle of the jaw
  • You can always intubate with a blade that is too long, but never with one that is too short

Laryngoscope Blade Sizing:

Age Laryngoscope Blade Size
Pre-term Neonate Straight 0
Neonate, Infant Straight 1
1 – 6 years Curved 1-2
6 – 12 years Curved 2-3
> 12 years Curved 3-4

 

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