Intubation Essentials with Dr. Alyssa Stoner and Dr. Gina Patel, Part 1 Preparation and Checklists

Dr. Alyssa Stoner is an Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine and practicing pediatric intensivist at Children's Mercy Kansas City.
Dr. Gina Patel is a fellow in pediatric critical care at Children's Mercy Kansas City.

Objectives

• The participant will be able to compile a complete list of equipment necessary to perform a pediatric intubation, with acknowledgment of mnemonic.
• The participant will be able to determine the appropriate size and depth of insertion of endotracheal tube based on patient’s age utilizing a common estimation formulas.
• The participant will be able to describe the appropriate patient set up; including positioning for a successful intubation. 

When a checklist is elusive a simple mnemonic can be helpful to recall the necessary equipment:

Mnemonic: SOAP ME

Suction Device: Ensure suction is turned on and at appropriate level

• Yaunker or large bore suction tube 14 French
• Consider second suction set up especially if concerned about pulmonary hemorrhage or pulmonary edema

Oxygen Delivery system: ensure oxygen sources is connected and functioning appropriately

• Nasal Cannula vs. High Flow/ Non-Rebreather
• Consider non-Invasive if poor oxygenation
• Consider need for apneic oxygenation depending on clinical situation 
• Self-inflating anesthesia bag with appropriately sized mask 

Airway Equipment:

• Direct Laryngoscope: Blade type and size considerations 
• Video Laryngoscope: CMAC or Glidescope dependent upon access and comfort 
• Endotracheal tube: Correct size + size down
• Back up airway IE: Laryngeal Mask Airway (LMA)

Patient Position: Most of procedural success is based upon the appropriate patient positioning

Medication plan: specific to patient and clinical scenario, there are many combinations that can be utilized and some for specific scenarios. 

Equipment: ensure all monitors placed appropriately (BP cuff and pulse ox on separate extremities)

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