Pre-hospital intubation for pediatric trauma victims is not necessary
Table of Contents
AIRWAY MANAGEMENT IN EMERGENGIES 3
PAEDIATRICS AIRWAY ANATOMY 4
IS PRE-HOSPITAL INTUBATION FOR PAEDIATRICS TRAUMA VICTIMS NECCESSARY? 6
The data from World Health Organization (WHO) on the leading causes of death worldwide and the global burden of diseases shows that, traumatic injuries are the major cause of mortality, morbidity and disability among children (0 – 14 years) - being responsible for more deaths than the combination of other diseases1. It is against this backdrop that pre-hospital care during emergencies becomes very important in the management of the injured children as it is for adults. In most circumstances, earliest responder who could be a medical doctor, paramedic, or even layman are the first to provide the much needed life saving (basic or advance), vital medical care all with the aim of optimizing the victim’s physiological status prior to arriving nearest medical facility2, 3. Indeed, several evidences suggested that these first life-saving supports have effect on the morbidity and mortality of the injured patient2-4. But, recent researches have also shown that interventions like invasive airway management, IV access and fluid administration are associated with higher rate of complication and failure among paediatric patients, while the few that turned out to be successful were provided by specially trained and experienced personnel3. This is due to the difference in size and overall anatomy of children compared with adult, thus many of these procedures turn out to be difficult or results in complication when performed by untrained or unskilled personnel.3, 4
AIRWAY MANAGEMENT IN EMERGENGIES
Respiratory insufficiency and its resultant respiratory arrest is the leading cause of cardiac arrest in children unlike adults where cardiac related problems are the main cause of cardiac arrest, 2, 5 hence, the need for providing paediatrics trauma victims with optimal airway support.
Basic airway management are the fundamental skills required by any emergency health care provider to enable them provide victims with a certain degree of airway protection. Basic airway management skills can be acquired fairly easily and comprise of safer, non-invasive ventilation (NIV) techniques - NIV is based on the cyclical application of a positive pressure (or volume) to the airways.6 Furthermore, in most cases, bag mask valve (BMV) ventilation is often used for general airway management7 while evidences have shown that BMV is the best option for pre-hospital airway support for paediatric patients.11, 15
Advanced airway management unlike the basic airway support is a low frequency skill with a very high potential of risk because it involves using invasive ventilation techniques (i.e. intubation). In this regard, endo-tracheal tube (ETT) is the most...