Paediatrics - epiglottitis

Assessment:

Goals

· Don’t bother the child

· How obstructed?

· How sick?

History

· From parent and medical records

· HOPC: activity? Appetite? Wet nappies?

· PMHx: any problems?

· PSHx: previous surgery? Airway difficulty? Notes?

· Medications

· Allergies

· Fasting status

· Usual exercise tolerance

Examination

· From end of bed assessment only

· A&B: drooling? Stridulous? Hypoxaemic?

· C: pale? Shut down? Floppy?

*high risk*

Airway

· Abnormal – swollen, obstructed

· Unfasted

Circulation

· Sepsis

Child

· Won’t like proper assessment

· Won’t like proper positioning = separation from parent

· Won’t like inhalational induction

· Won’t like awake IV

· Pre-med likely unsafe

Discussions	· Whole team: need to intubate now, or safe to transfer to tertiary care? · Parent: overall plan, induction plan, what to expect · ENT: scrubbed for FONA (“double set-up”) · ICU: happy to accept post-op
Prepare	· Monitoring: sat probe, capno, gas analysis · Assistance: nurse (airway), 2^nd anaes (IV), surgeon (FONA) · Drugs: IM sux 4mg/kg, IM atropine 20mcg/kg, IV propofol 3mg/kg · Equipment: Mapleson F circuit, suction, face mask, small ETT with stylet, direct and video laryngoscopes
Induction	· Goal: maintain spontaneous ventilation · Child in parent’s arms · Sevoflurane in oxygen · Check pupils midline · Transfer to bed · Test jaw thrust · Direct laryngoscopy · Compress chest wall to see bubbles · Intubate
Afterward	· IV anaesthesia · Convert to nasal ETT · Transfer to ICU · Don’t extubate until afebrile and cuff leak