Evaluation Of A Pediatric Airway

The first step in evaluating a pediatric airway is a directed history and physical examination. The time course of the present episode should be determined, as should a history of any recent fever, cough, or sore throat. Any history of previous airway problems should be elicited. If time permits, the history should include a review of the antenatal and perinatal periods, with an emphasis on feeding or sleeping difficulties. Any history of snoring or noisy breathing, recurrent croup or upper respiratory infections, or cyanosis or coughing during feedings should alert the clinician to the possibility of an abnormal airway.

The physical examination of a pediatric patient may be hindered by lack of cooperation, and care should be taken not to frighten the child. Visual signs of possible airway compromise include tachypnea, cyanosis, drooling, nasal flaring, and intercostal retractions. The child may assume a "tripod" position to enhance the use of accessory respiratory muscles. Auscultation may reveal stridor, wheezing, or grunting. Any change in the child's mental status, including agitation or somnolence, may further indicate airway difficulties. As in adults, features suggesting potentially difficult intubation include a small or recessed mandible, a prominent tongue, prominent upper incisors, and impairment of neck mobility.

Pediatric patients often have a period of compensated respiratory compromise prior to an arrest. 4 Pulse oximetric measurements should be continuously monitored, but adequate oxygen saturation should not be considered assurance of respiratory stability, since this measurement may not reflect declining ventilatory performance. All patients with potential airway compromise require attentive observation and frequent examination.

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