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Atlas of Practical Neonatal & Pediatric Procedures
Jayashree Sood, Pradeep Jain, Deepanjali Pant
1:
Airway Management
Normal Pediatric Airway
Pediatric Airway Devices and Associated Equipment
FACE MASKS
Advantages
Disadvantages
Complications
AIRWAYS
Complications
Oropharyngeal Airways
Nasopharyngeal Airways
AIRWAY DEVICES
SUPRAGLOTTIC DEVICES
Laryngeal Mask Airway
Cuffed Oropharyngeal Airway (COPA)
Laryngeal Tube (LT)
Laryngeal Tube Suction (LTS) Device
Cobra Perilaryngeal Airway (Cobra PLA)
Esophageal Tracheal Combitube (ETC)
INFRAGLOTTIC DEVICES
Endotracheal Tubes (ETTs)
Cuffed Endotracheal Tube
SPECIAL TYPES OF ETT
Cole Tube (Fig. 1.34)
Flexometallic Tube (Armoured/Reinforced/Spiral Embedded Tube) (Fig. 1.35)
Preformed Tube (Ring-Adair-Elwyn Tube/RAE Tube) (Figs 1.36A and B)
Parker Flex-tip Tube (Pft Tube) (Figs 1.37A and B)
Hi-Lo Jet Tracheal Tube (Fig. 1.38)
Options for One-Lung Ventilation
TRACHEOSTOMY TUBES (TT) (Figs 1.43A to C)
Indications of Tracheostomy
ALTERNATIVES TO CONVENTIONAL RIGID LARYNGOSCOPY IN CHILDREN
Endotracheal Tube Guides
Lighted Stylets
Trachlight
Laryngoscopes
Special Airway Techniques
FLEXIBLE FIBEROPTIC INTUBATION (FFI) (Figs 1.58A AND B)
Advantages
Disadvantages
Indication
Key-points for Procedure
Contraindications
RETROGRADE INTUBATION
Indications
Technique
Limitations
CRICOTHYROTOMY
Needle Cricothyrotomy
Percutaneous Dilatational Cricothyrotomy (PDC)
Surgical Cricothyrotomy
TRACHEOSTOMY
Indications
Difficult Airway
COMMON CAUSES OF DIFFICULT AIRWAY
MANAGEMENT STRATEGIES (FIG. 1.60)
DIFFICULT AIRWAY CART FOR PEDIATRICS (FIG. 1.61)
A Standard Airway Kit
A Difficult Airway Cart
2:
Vascular Access
Venous Access
PERIPHERAL VENOUS ACCESS
Indications
Technique
CENTRAL VENOUS ACCESS
Indications for Central Venous Access
Contraindications
Choice of Veins
INTERNAL JUGULAR VEIN CANNULATION
Technique
Approaches
Advantage
Complications
SUBCLAVIAN VEIN CANNULATION
Technique
Caution
Advantages
Disadvantages
Complications
EXTERNAL JUGULAR VEIN CANNULATION
Indication
Technique
Advantages
Disadvantages
FEMORAL VEIN CANNULATION
Indications
Contraindications
Technique
Advantages
Disadvantages
PERIPHERALLY INSERTED CENTRAL CATHETER (PICC) PLACEMENT
Indications
Contraindications
Technique
Merits
Demeritis
Routine Care of PICC Line
Indications for Removal of Catheter
UMBILICAL VENOUS CATHETERIZATION (UVC)
Indications
Technique
Location of Catheter Tip
Complications of UVC
Contraindications
Ascertainment of Correct Position of Central Venous Catheters (CVCs)
PERIPHERAL VENOUS CUTDOWN
Arterial Cannulation
INDICATIONS
SITES
EQUIPMENT
TECHNIQUE
General
Radial Artery Cannulation (Figs 2.23A to E)
Dorsalis Pedis/Posterior Tibial Artery Cannulation (Figs 2.24A and B)
Umbilical Artery Catheterization (UAC)
SETTING UP TRANSDUCER FOR CONTINUOUS PRESSURE MONITORING (Fig. 2.26)
CARE OF THE ARTERIAL LINE
REMOVING THE ARTERIAL LINE
Intraosseous Vascular Access
INDICATION
ACCESS SITES
PROCEDURE
POTENTIAL COMPLICATIONS
EFFECTIVENESS OF IO VERSUS IV ACCESS
3:
Pain Management
Assessment of Pain
PHYSIOLOGICAL PARAMETERS
BEHAVIORAL MEASURES
COMPOSITE MEASURES
SELF REPORT
Management of Postoperative Pain
Topical Analgesia
EUTECTIC MIXTURE OF LOCAL ANESTHETICS (EMLA) (Fig. 3.4)
Indications
Contraindications
Wound Irrigation
Wound Infiltration
Regional Analgesia Techniques
COMMON PRINCIPLES FOR A SAFE AND EFFECTIVE BLOCK
Neuraxial Block
PHYSIOLOGY AND DRUG PHARMACOKINETICS IN THE PEDIATRIC AGE GROUP
Epidural Analgesia
CURRENT TREND OF ADJUVANTS USED IN EPIDURAL SPACE
SINGLE–SHOT CAUDAL EPIDURAL (Figs 3.7A and B)
Technique
THREADING A CAUDAL EPIDURAL CATHETER TO LUMBAR/THORACIC SPACE
Indications
Advantage
Confirmation of Epidural Catheter Tip
LUMBAR EPIDURAL BLOCK
Indications
Technique
THORACIC EPIDURAL ANALGESIA
Indication
Key Points
Disadvantage
Technique
Subarachnoid Block
INDICATIONS
TECHNIQUE
DOSAGE
CLINICAL PEARLS FOR SAFETY AND EFFECTIVENESS OF SUBARACHNOID BLOCK
ADVERSE EFFECTS
COMBINED SPINAL EPIDURAL ANALGESIA
CONTRAINDICATIONS FOR NEURAXIAL BLOCK
Infraorbital Nerve Block
ANATOMY
INDICATIONS
TECHNIQUES
Intraoral Approach (Fig. 3.14B)
Extraoral Approach (Fig. 3.14C)
COMPLICATIONS
Brachial Plexus Block
AXILLARY APPROACH (FIGS 3.15A TO C)
INDICATIONS
TECHNIQUE
DOSAGE
Intercostal Block
INDICATIONS
KEY ANATOMY (FIGS 3.16A AND B)
TECHNIQUE
DOSAGE
Paravertebral Block (Figs 3.17A and B)
INDICATIONS
TECHNIQUE
FORMULA
DOSAGE
COMPLICATIONS
Ilioinguinal and Iliohypogastric Nerve Block (ILIH) (Figs 3.18A to C)
INDICATIONS
ANATOMY
TECHNIQUE
ADVANTAGE
DISADVANTAGES
Transversus Abdominis Plane Block (TAP Block) (Figs 3.19A and B)
INDICATIONS
ANATOMY
TECHNIQUE
DOSE
COMPLICATIONS
Penile Block (Figs 3.20A to C)
INDICATIONS
ANATOMY
TECHNIQUE
DOSAGE
KEY POINTS FOR A SAFE AND EFFECTIVE BLOCK
OTHER METHODS
Femoral Nerve Block (Figs 3.21A and B)
INDICATIONS
ANATOMY
TECHNIQUE
DOSAGE
Psoas Compartment Block (PCB) (Figs 3.22A and B)
INDICATIONS
ANATOMY
TECHNIQUE
ADVANTAGES
COMPLICATIONS
Fascia Iliaca Compartment Block (Figs 3.23A and B)
TECHNIQUE
DOSE
COMPLICATION
Sciatic Nerve Block (Figs 3.24A and B)
INDICATIONS
DRUG
TECHNIQUE
POSTERIOR APPROACH
Popliteal Fossa Block (Figs 3.25A and B)
DOSE
4:
Procedural Sedation and Analgesia
Objective
Levels of Sedation
MINIMAL SEDATION (ANXIOLYSIS)
MODERATE SEDATION/ANALGESIA (CONSCIOUS SEDATION)
DEEP SEDATION/ANALGESIA
GENERAL ANESTHESIA
Preparation for Sedation
PRE-SEDATION ASSESSMENT
DOCUMENTATION
CHOICE OF DRUGS (TABLE 4.2)
Clinical Pearls for Procedural Sedation
Recommended Guidelines for Safe Sedation
Recommended Discharge Criteria
5:
Pediatric Cardiopulmonary Resuscitation
Prevention of Cardiopulmonary Arrest
BLS Sequence
RATIONALE FOR THIS CHANGE
MANEUVERS RELATED TO CPR
Recovery Position
HIGH-QUALITY CHEST COMPRESSIONS
Technique
OPEN AIRWAY AND GIVE VENTILATION (Fig. 5.6)
BREATHING ADJUNCTS
DEFIBRILLATION
INTEGRATION OF DEFIBRILLATION SEQUENCE WITH RESUSCITATION SEQUENCE
BLS Sequence for Lay Rescuer
BLS Sequence for Health Care Provider (HCP)
CHEST COMPRESSION
VENTILATION
Pediatric Advanced Life Support (PALS)
Emergency Fluids and Medications
VASCULAR ACCESS
ENDOTRACHEAL ROUTE
FLUIDS
MEDICATIONS (Table 5.1)
Adenosine
Amiodarone
Atropine
Calcium
Epinephrine
Glucose
Lidocaine
Magnesium
Procainamide
Sodium Bicarbonate
Post-resuscitation Stabilization
OBJECTIVES
APPROACH
Major Changes Introduced in 2010 CPR Guidelines
Foreign Body Airway Obstruction (FBAO)
DIAGNOSIS
MANAGEMENT (Fig. 5.10)
6:
Procedural Sedation and Analgesia
Steps of Resuscitation
INITIAL STEPS IN STABILIZATION
Temperature Control
Clearing the Airway
Rationale for Such Recommendations
Oxygen Need and Administration
POSITIVE PRESSURE VENTILATION
Assisted Ventilation Devices
CHEST COMPRESSIONS
VOLUME EXPANSION
Post-resuscitation Care
GUIDELINES FOR WITHHOLDING OR DISCONTINUING RESUSCITATION
Withholding Resuscitation
Discontinuation of Resuscitation
Neonatal Resuscitation Equipment and Medications
INDEX
TOC
Index
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