For a detailed discussion of pediatric upper airway obstruction, see Chap 129. Optimal airway management for pediatric patients with epiglottitis is in the operating room. If the patient is stable, he or she should be transported to the operating room accompanied by a skilled airway manager and the proper equipment. A patient with complete airway obstruction can often be ventilated until an airway can be established. If this is unsuccessful, emergent orotracheal intubation should be attempted. If this fails, invasive airway techniques should be utilized.
Uncommonly, a child with croup may be unresponsive to medical management and may require an artificial airway. An endotracheal tube is optimally placed in the operating room allowing for inhalation induction of anesthesia. Intubation, however, may have to be performed in the emergency department if the patient is in extremis.
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