INSTRUMENTS
Endotracheal tube
• Made of plastic. Has a radio opaque line
• Sizes : 2 – 6.5
• Size is the internal diameter in mm
• Length is from tip in cm
• Depth of tube can be estimated by multiplying
the tube size into 3
• Tip placed above carina
Endotracheal tube
• Cuffed : > 8 years
• Prevents displacement and aspiration
• Uncuffed : < 8 years
• Deciding tube- age in years /4 + 4 for un cuffed (+
3.5 for cuffed)
• Sizes available 2.0 to 6.5
• Preterm : 2 – 2.5 mm
• Term : 3 – 3.5 mm
• 1 – 6 months : 3.5 – 4.5 mm
• 6 months – 1 yr : 4.5 – 5 mm
Uses :
• Imminent arrest
• Low GCS
• Respiratory failure
• Hypotensive shock
• Suctioning of trachea in meconium aspiration
Complications :
• Mechanical trauma to oral cavity
• Stimulation of post pharyngeal wall – vasovagal episodes
• Pneumothorax
• Prolonged intubation – pressure necrosis of larynx
Steps of intubation :
• Nasogastric tube insertion
• Preoxygenation of child for 2 – 3 min
• Positioning
• Intubation
• Confirm tube position
Confirmation of tube position :
• 5 point auscultation
• Right infraclavicular
• Left infraclavicular
• Right infra axillary
• Left infra axillary
• Stomach
Laryngoscope
• Blade- miller, Mac Intosh
• straight for < 1 year, curved for > 1 yr
• straight- lift epiglottis, curved- lift vallecula
• uses- intubation, direct laryngoscopy
• sizes- 0 to 4, 0 for neonate, 4 for adult
• handle- battery container
• complication- injury to teeth and lips/ tongue
Ambu bag
• Artificial Manual Breathing Unit
• Self inflating bag valve mask/ non rebreathing/ silicon
bag
• Size- 250 ml neonates, 500 ml pediatric, 1500 ml
adult
• Parts-
• Bag-mask ventilation is used to provide
oxygenation and ventilation for a child with
• apnea
• bradypnea,
• hypoxemia.
Contraindications :
Meconium aspiration
Diaphragmatic hernia
EC-clamp technique :
The E-clamp is provided using the
Middle finger - mentum,
Ring finger - ramus
Little finger - angle of the mandible
The E-clamp acts as a bucket handle to lift the jaw to meet the C-clamp
such that the seal is airtight.
The C-clamp is provided using the thumb and index finger
to encircle the mask along its rim.
EC clamp technique
Signs of effective BMV :
• Visible chest rise
• Improvement in Oxygen saturation
• Improvement in heart rate
Face mask
• Made of silicon
• Types- circular,
• Size- cover mouth nose chin, does not cover
eyes
Nebuliser mask
• parts- air inlet, chamber, baffle, cap
Jet nebuliser :
• Jet of gas forced thru narrowed lumen
• Negative pressure in chamber
• Solution is aerosolised into droplets
Ultrasonic nebuliser :
How to Use a Nebulizer?
• Assemble the tubing, nebulizer cup and mouthpiece
• Load the prescribed drug in a syringe.
• Fill the nebulizing chamber with the medication.
• Fill the chamber with 4–5 mL of normal saline. If
lesser volume is used, nebulization may not be
possible (avoid distilled water)
Metered Dose Inhaler (MDI)
• Acute attack of asthma
• Long term maintenance therapy
Limitations :
• Requires perfect co-ordination between
inspiration and activation of device which is
not possible in small children
• Drug wastage – deposition in oropharynx
Spacer
• Acts as a reservoir for aerosolised drug
• Greater drug delivery to lungs
• Less wastage to atmosphere
• Reduces deposition in oropharynx
• Age < 4 yrs – use with
face mask
• Age > 4 yrs – without
face mask
• 8 – 10 breaths are
needed to completely
empty the spacer
Bone marrow needle
• parts- trochar, canula, adjustable side guard
• Size – 16 ,18 ( standard), 20
• sites- upper 3rd of tibia, post superior iliac
spine
Uses
• Bone marrow aspiration
Diagnostic
• Hematologic – aplastic anemia, leukemia,
lymphoma , ITP, hemolytic anemia
• Infections – typhoid, Kala azar
• Storage disorders
Therapeutic :
• Intraosseous access
• All drugs can be given except oxygen
Suction catheter
• Size- 6, 8, 10, 12 Fr
• Open tip
• Uses- ET suction, oral suction
Feeding tube
• Made of plastic, round tip with opening on lateral
sides with radio opaque lining
• Size – 5 to 12
• How to insert?- NG/OG
• Uses- feeding preterm, suctioning, aspirating
gastric contents, checking patency of nasal
cavity/esophagus/ anus
• Complication- accidental intra tracheal insertion,
too deep/ superficial
• Measurement/ checking position
Spinal needle
Indications
Site
Contraindications
• L3, L 4 space
Indications
Diagnostic
• Infections – Meningitis, Encephalitis
• Inflammatory - Guillain barre syndrome
• Malignancies – leukemia
• Subarachnoid hemorrhage
Therapeutic
• Spinal and epidural anaesthesia
• Chemotherapeutic drugs administration
( intrathecal route)
Contraindications :
• Cardiorespiratory compromise
• Increased intracranial tension
• Bleeding disorders
• Local infections
• Previous lumbar surgeries
Pressure :
Newborn 90 – 120 mm H2O
Young children 60 – 180 mm H2O
Older children 12 – 120 mm H2O
Cells : 0 - 5 / mm3 WBCs
• Polymorphonuclear cells are always abnormal
• Increased polymorphs – bacterial meningitis
• Lymphocytosis – aseptic meningitis, TBM, fungal meningitis
RBCs – NIL
• If present – traumatic tap or subarachnoid hemorrrhage
Proteins : 20 – 40 mg (newborns upto 120 mg)
• Increased – meningitis, GBS, CSF block, tumors
Glucose : 40 – 70 mg (60% of plasma glucose)
• Decreased – bacterial, tuberculous, viral,
meningitis
Bulb sucker
• Uses- suctioning mucus from mouth and nose
of a neonate
• Mouth followed by nose to prevent aspiration
• How to use?
Intercostal drainage tube
• Mallecots self retaining catheter
Site :
• 4th , 5th, 6th intercostal space
• Upper border of rib
Indications :
• Pneumothorax
• Pleural effusion
• Empyema
• Hemothorax
• Pleural fluid analysis: TRANSUDATE
Pleural fluid protein <0.5 CCF
Serum protein Cirrhosis
Nephrotic
Pleural fluid LDH < 0.6 syndrome
Serum LDH
• Pleural fluid analysis: EXUDATE
Pleural fluid protein >0.5 Infections
Serum protein malignancy
trauma
Pleural fluid LDH > 0.6
Serum LDH