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Fifteen-minute consultation: Intubation of the critically ill child presenting to the emergency department
  1. Constantinos Kanaris1,2,
  2. Peter Croston Murphy3,4
  1. 1 Department of Paediatric Intensive Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  2. 2 Blizard Institute, Queen Mary University of London, London, UK
  3. 3 Department of Paediatric Anaesthesia, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
  4. 4 North West and North Wales Paediatric Transport Service, Royal Manchester Children's Hospital, Manchester, UK
  1. Correspondence to Dr Constantinos Kanaris, Paediatric Intensive Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK; ckanaris{at}doctors.net.uk

Abstract

Intubation of critically ill children presenting to the emergency department is a high-risk procedure. Our article aims to offer a step-by-step guide as to how to plan and execute a rapid, successful intubation in a way that minimises risk of adverse events and patient harm. We address considerations such as the need for adequate resuscitation before intubation and selection of equipment and personnel. We also discuss drug choice for induction and peri-intubation instability, difficult airway considerations as well as postintubation care. Focus is also given on the value of preintubation checklists, both in terms of equipment selection and in the context of staff role designation and intubation plan clarity. Finally, in cases of failed intubation, we recommend the application of the Vortex approach, highlighting, thus, the importance of avoiding task fixation and maintaining our focus on what matters most: adequate oxygenation.

  • intensive care units
  • paediatric
  • paediatric emergency medicine
  • resuscitation
  • paediatrics

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Footnotes

  • Twitter @DrKanaris

  • Correction notice This paper has been updated since it was published online. There was an error in table 1 on the dose of adrenaline for resuscitation which has since been corrected.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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