**5. Pediatrics**

Airway management in pediatrics is relatively difficult and requires highly skilled and professional personnel, this difficulty is based on the physiological, anatomical differences between infant, pediatric, and adult airways [19]. These differences included in the following table:


**31**

*Airway Management in the Pre-Hospital Setting DOI: http://dx.doi.org/10.5772/intechopen.94999*

Foreign body aspiration is a common problem in the pediatric population, it may cause severe airway obstruction and might mandates immediate intervention. Other causes that might mandate airway intervention in the pediatric group include

Inhalational injury is a broad non-specific term that encompasses damage inflicted by heat, smoke, or chemical irritants to the respiratory tract or lung tissue. Inhalational injury is commonly associated with burn injuries, around 10–20% of burn victims also suffered from inhalational injury complications that increased morbidity and mortality [22], moreover inhalation injury is considered an indepen-

All burn patients should receive humidified 100% oxygen though a facemask to displace carbon monoxide [23], Advanced Life support of the American burn association recommends early endotracheal intubation, if there is any of the follow-

The use of prehospital advanced airway management techniques in the pediatric population have shown to have a conflicting result, in a recent nationwide cohort study, that looked into the outcome of out of hospital cardiac arrest in the pediatric population of japan, the use of advanced airway management technique including ETI and supraglottic devices did not demonstrate any improvement in 1-month survival or functional status when compared to the use of basic airway techniques [20]. Despite the conflicting results of the use of advanced airway management techniques, the use of supraglottic airway devices has been shown to easy, simple and with minimal complications in simulated pediatric cardiac arrest scenarios [21]. A useful tool to help guiding the sizes and dosages of the equipment and medications in the pediatric group is the Broselow Pediatric Emergency Tape, also known as the Broselow Tape, a color-coded tape that matches the measured height to the

epiglottitis, viral croup, trauma, seizures, hypoxia, and cardiac arrest.

child's expected weight and other needed information.

dent predictor of mortality in burn victims.

• Total burn surface area more than 40%

• Extensive facial burns or involvement of the oral cavity

• In patient with large burns, absence of qualified personnel to perform

**7. Prehospital airway management during COVID 19 pandemic**

Current recommendations for the airway management of patient with respiratory failure due to novel Corona virus II infection are focusing on

• Signs of Airway obstruction

• Significant facial edema.

• Signs of respiratory distress

intubation during transfer.

• Disturbed level of consciousness

• Difficult swallowing

**6. Inhalation injury**

ing indicators:

*Special Considerations in Human Airway Management*

trauma victims.

Apneic patient

Significant faciomaxillary fractures

In most of the cases of trauma victims, simple maneuvers are usually sufficient to overcome upper airway obstruction, but in cases were simple techniques were ineffective the aim should be toward establishing a definitive airway technique. In an prospective observation study Lockery and his colleagues investigated the effectiveness prehospital advanced airway management in trauma patient, among the patient whom had received advanced airway management technique around 57% of them had airway compromise upon there arrival to the trauma centers, the success rate of ETI for non-physician paramedic was 64% and 11% reached a health care facility with unrecognized esophageal intubation. While physician-paramedic teams achieved definitive airway management for all patients [17]. Therefore, level of training, and availability of expertise are important in situations when advanced

airway technique is warranted in trauma patient population group.

Protect from aspiration of vomitous content or airway bleeding Reduced level of consciousness (Glasgow Coma Scale <8)

Inhalational injury with impending or potential airway compromise Failure to maintain oxygenation using facemask or BiPAP/CPAP

Advanced airway management techniques include ETI or a surgical airway. Below is a list of the most common indications for advanced airway technique in

It is recommended to assume that patients with major trauma, head and facial injuries, decreased level of consciousness or with neck pain as having cervical spine injury thus warranting cervical immobilization techniques to prevent further damage. Cervical immobilization has been known to attribute to difficulties with laryngoscopic view and hence difficult airway management. In a prospective study by Heath, that investigated the effect of different cervical spine immobilization techniques on the ease of laryngoscopy, poor view on laryngoscopy (grade 3 or 4) was more encountered when the cervical spine immobilized using rigid collar, tapes and sandbags compared to in-line manual immobilization. Therefore, manual in-line stabilization of cervical spine is the method of choice during tracheal intubation [18].

Patient who is at risk of upper airway obstruction: neck hematoma, laryngeal and tracheal injury

Airway management in pediatrics is relatively difficult and requires highly skilled and professional personnel, this difficulty is based on the physiological, anatomical differences between infant, pediatric, and adult airways [19]. These

**30**

**5. Pediatrics**

Large occiput

High and anterior larynx Large and floppy epiglottis

differences included in the following table:

Relatively larger tongue and small mouth

Subglottic narrowing at the cricoid cartilage

Foreign body aspiration is a common problem in the pediatric population, it may cause severe airway obstruction and might mandates immediate intervention. Other causes that might mandate airway intervention in the pediatric group include epiglottitis, viral croup, trauma, seizures, hypoxia, and cardiac arrest.

The use of prehospital advanced airway management techniques in the pediatric population have shown to have a conflicting result, in a recent nationwide cohort study, that looked into the outcome of out of hospital cardiac arrest in the pediatric population of japan, the use of advanced airway management technique including ETI and supraglottic devices did not demonstrate any improvement in 1-month survival or functional status when compared to the use of basic airway techniques [20].

Despite the conflicting results of the use of advanced airway management techniques, the use of supraglottic airway devices has been shown to easy, simple and with minimal complications in simulated pediatric cardiac arrest scenarios [21].

A useful tool to help guiding the sizes and dosages of the equipment and medications in the pediatric group is the Broselow Pediatric Emergency Tape, also known as the Broselow Tape, a color-coded tape that matches the measured height to the child's expected weight and other needed information.
