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EMR
EMT
AEMT
Paramedic
Extended
Pediatric Intubation Guidelines
These are general guidelines for all EMS personnel to assist in the decision making process when dealing with a
critically ill or injured child. There are no absolute rules that mandate if any given child requires definitive
airway versus conservative assistance such as oral airway with BVM. There are many factors that determine the
need for definitive airway and all have to be considered.
Nature of the situation:
Is there a corrective action that may quickly improve the condition (glucose for
hypoglycemia, naloxone for narcotic overdose, aerosols for severe bronchospasm) or is the condition going to
worsen over time (head trauma, hemorrhagic shock, airway edema / obstruction).
Skill level of the available providers:
If the available medics are unsure of their pediatric intubation skills and
the child is oxygenating well, with adequate airway protection, there should not be an imminent urgency to
attempt intubation.
Oxygenation and patent airway
are the most important issues in determining the need for pediatric intubation.
Hypercarbia (high CO2) and Glasgow Coma Scale are determinants used in the hospital but these should not be
extrapolated to the field. If a child has a patent airway and is oxygenating well, intubation is not mandatory.
If intubation of a child is needed remember the following:
1.
Use a cuffed tube whenever possible but in children under 8 only inflate if needed to oxygenate / ventilate
due to air leak
2.
Tube size = Age + 16
4
Length = 12 + age/2
Pediatric Intubation Guidelines