INSTRUMENTS

• The laryngoscope consists of a Handle (which also houses the

batteries] & the blade (which contains the light source).
• The Blade is detachable & can be either a Straight blade (Miller) or
a Curved blade (Macintosh)
• In younger children (< 8 years) - The straight blade is more useful as
compared to the curved blade as the larynx is situated more
anteriorly
• In older children & adolescents, the curved blade is more useful as
the broader & stronger curved blade helps in properly displacing the
tongue.
Uses :
• Mechanical Ventilation.
• Neonatal asphyxia
• Meconium aspiration
• Respiratory distress syndrome

Complications of the procedure :

• Mechanical injury - Injury to local tissues like teeth, tongue, palate,
etc. by the blade of laryngoscope.
• Stimulation of posterior pharyngeal wall may cause vaso-vagal
episode leading to hypoxia, bradycardia, etc or may cause coughing,
vomiting etc.
• Hyper-extension of the neck of the patient may cause damage to the
cervical spine.
• Proximal end - 15 mm adapter (connector) which fits to a ventilator or
Ambu Bag.
• Central Portion - has :
• A Vocal Cord Guide (black line) which should be placed at the level of
the opening of vocal cords so that the tip of the ET tube is positioned
above the bifurcation of the trachea.
• A Radio-opaque marker which is essential for accurate visualisation of
the position of the ET tube within the trachea by means of an X-ray.
• A distance indicator (marked in centimeters) which facilitates
placement of ET tube.
• A Cuff - in case of cuffed ET tube.
• Distal end - Has Murphy’s eye (opening in the lateral wall) which
prevents complete blockage of ET tube in case the distal end is
impacted with secretions, blood, etc.
• Cuffed ET tubes are used in children > 8 years of age.
• The cuff when inflated maintains the ET tube in proper position &
prevents aspiration of contents from the GI tract into the respiratory
tract.
• In younger children (< 8 years of age), uncuffed ET tubes are used
because the narrow subglottic area performs the function of a cuff &
prevents the ET tube from slipping.
Uses:

Complications :
• Mechanical trauma to tongue, teeth, palate, pharynx & larynx during
intubation procedure.
• Stimulation of posterior pharyngeal wall leading to coughing,
vomiting or vasovagal episode with resultant hypoxia, bradycardia,
etc.
• Prolonged intubation may cause pressure necrosis of laryngeal
structures leading to persistent hoarseness
Uses :
In Resuscitation for giving Intermittent
Positive
Pressure Ventilation.
NRM
8-15 lit/min
80-100%

The mask is of the right size if

it covers the nose & mouth
including the tip of the chin but
not the eyes.
Nasal Oxygen Catheter :
• It is a plastic tube which has a loop at one end.
• At the end of the loop it has two prongs.
• Prongs are meant to be inserted into the anterior nostrils to deliver
oxygen.
• The other end of the plastic tube is meant to be attached to the
oxygen source.
• The nasal prongs are of 2 sizes : Pediatric & adult.
Uses :
• It is meant to deliver oxygen to the nasopharynx, leaving the oral
cavity free.
• Thus, more comfortable to the patient as it allows speech & nutrition.
 • The MDI is used for long-term maintenance therapy of Asthma.
• It consists of a metallic canister which contains the medicine along
with a propellant which delivers the medicine to the patient in the
form of an aerosol.
• The canister is inverted & fixed to the inhaler before actuating the
device.
• The patient breathes out & then puts the mouthpiece of the inhaler in
his mouth.
• By pressing on top of the inverted canister, a puff of the aerosolized
medicine is generated.
• The patient should take a deep inspiration as soon as the puff is
generated & then hold his breath for a few seconds before breathing
out gently.
Uses :
• Treatment of acute attack of asthma.
• Maintenance therapy for prevention of repeated attacks of asthma.
Medicines that can be given via MDI are :
• Inhaled beta 2-agonist drugs :
• Short-acting : Salbutamol; Terbutaline (Used to terminate
acute episodes of bronchial asthma).
• Long-acting : Salmeterol; Formoterol (Used in maintenance
therapy for those with persistent asthma).
• Inhaled anticholinergic drugs like Ipratropium bromide.
• Inhaled mast-cell stabilizers - like Cromolyn sodium.
• Inhaled steroids - like Beclomethasone, Fluticasone or
Budesonide.
Side-effects :
• Tremors, Tachycardia, Palpitations –
• Oral candidiasis - due to deposition of steroids in mouth.
• Sore throat - due to deposition of steroids in pharynx & larynx.
• The disadvantage of an MDI is that it requires perfect co-ordination
between inspiration & activation of the device.
• This may not be possible in small children.
• To eliminate this problem, Spacers are devised.
• The mouthpiece is inserted into the mouth, (or attached to a face-
mask in case of infants or younger children).
• By breathing through the spacer for about 10 times, the aerosolized
medicine contained within the spacer can be delivered to the lungs.
 • The DPI's are more suitable for older children above 5
years of age, as they require a greater inspiratory effort.
Advantages of DPI :
• Small, portable devices.
• No need to co-ordinate inspiration with device actuation
(as the case with MDI’s).
Disadvantages of DPI :
• Cannot be used in children below 5 years of age.
• The dry powder can be deposited in the mouth or pharynx
if the inspiratory effort is not good.
• The dry powder may be affected by moisture in humid
climates.
Medicines that can be given by DPI’s : Same as MDI’s.
• No. 5 to No. 12 are commonly used in Pediatric Practice.
Uses of Infant - Feeding tube :
• Diagnostic Uses :
• Diagnosis of internal bleeding in stomach & upper GIT
• Diagnosis of Tuberculosis (Gastric lavage —examined for AFB)
• Diagnosis of Tracheo oesophageal fistula
• Diagnosis of Poisoning (Gastric aspirate used for chemical analysis).
• Localization of Oesophageal strictures.
• Therapeutic Uses :
• Nasogastric Feeds.
• Management of haematemesis.
• Conservative Treatment of Intestinal obstruction.
• Management of Poisoning.
• Administration of drugs.
• Pre-operatively to decompress the stomach when sufficient time for
fasting is not available.
• Other Uses :
• As an Oxygen catheter.
• For nasal, endotracheal & Tracheostomy suction.
• As a tourniquet.
Procedure :
• The approximate length that the tube should be inserted can be
measured by adding the distance from the nose to the tragus to the
distance from the tragus to the xiphoid.
Uses :
• Urinary :
• To monitor urine output in shock or renal failure.
• To differentiate anuria from retention.
• For incontinence of urine.
• To give bladder washes (in Cystitis).
• For suprapubic cystostomy.
• Non-urinary :
• To arrest post-nasal bleeding in cases of intractable epistaxis.
• It is a 1 cc syringe with a white piston
Uses of the Tuberculin Syringe :
• To administer PPD for Mantoux Test
• To administer BCG vaccine.
• To administer Test doses of drugs such as Penicillin.
• To test for allergens in Bronchial asthma, Atopy.
• Insulin injections in Diabetes Mellitus.
• Giving small doses of drugse.g. Gentamicin,Phenobarbitone, Digoxin.
It consists of :
• Trocar
• cannula
• bifid needle
Uses
• Liver Biopsy
• Kidney Biopsy
Indications of Liver Biopsy :
• Cirrhosis of Liver :
• Cryptogenic Cirrhosis
• Indian Childhood Cirrhosis
• Biliary Cirrhosis
• Storage disorders :
• Glycogen Storage disorders
• Wilson’s disease
• Malignancy :
• Leukemia
• Lymphoma
• Wilm’s Tumour
• Hepatoblastoma
• Neuroblastoma
• The L-P needle (Spinal needle) consists of a pointed canula with a
hub at one end & a stillete which fits into the canula.
• Available in sizes from 16 G to 30 G (16 G being the largest & 30 G
being the thinnest).
Site:
• Between L4-L5 spinous process
• It consists of :
• A Stillete
• Thick body with nail
• A Guard 2 cms from the tip.
Uses :
• Bone - Marrow Aspiration
Indications of Bone - Marrow Aspiration :
• Diagnostic Indications :
• Idiopathic Thrombocytopenic Purpura
• Aplastic anemia
• Leukemia
• Megaloblastic anemia
• Infections —e.g. Kala-azar
• Storage disorders —e.g. Gaucher’s disease
• PUO
• Myelofibrosis
• Therapeutic Indications :
• Bone - marrow Transplantation.