4. .
In Older Children
Prior to endotracheal intubation:
• Resuscitation
• During admoinistration of general anaesthesia
• Epiglottitis
• Kerosene poisoning
Direct Laryngoscopy
• In cord palsy
• Anatomical lesions
• Foreign body
6. PROCEDURE
1. Gauze piece placed on upper teeth to protect
against trauma.
2. After lubrication, the laryngoscope is held by the
handle in the left hand. Right hand is used to
retract the lips and guide the scope.
3. It is introduced by one side of the tongue which
is pushed to the opposite side till posterior third
of tongue is reached.
4. It is advanced behind the epiglottis and lifted
forward without levering it on the upper teeth or
jaw
7.
8. Following structures are examined serially:
1. Base of tongue
2. Right and left valleculae
3. Epiglottis
4. Right and left pyriform sinuses
5. Arypeiglottic folds
6. Arytenoids
7. Post cricoid region
8. False cords
9. Anterior and posterior commissure
10.Ventricles and vocal cords
11.Subglottic area
9. Complications
• Mechanical injury
injury to local tissues like teeth,tongue,palate
• Stimulation of posterior pharyngeal wall may
cause vago-vagal episode leading to
hypoxia, bradycardia.
• Hyperextension of neck may cause damage to
cervical spine.
10. OXYGEN RESERVIOR
Small corrugated ,tube like structure usually made of plastic.
Has 2 open ends
One end is connected to air inlet of ambu bag, other end should be
left open.
USES:
Increase the FiO2 of the oxygen delivered to the patient by ambu
bag from 40% to more than 90%.
11. OXYGEN MASK
Usually made up of plastic or rubber.
TYPES:
Uncushioned
Cushioned
ADVANTAGES(of cushioned mask)
The mask conforms to the face
Requires less pressure to obtain air tight seal
Less chances of damage to eyes or other structures of the face
13. CHOOSING THE CORRECT SIZE OF THE MASK:
The mask is of right size if it covers the nose and mouth
including the tip of the chin but not the eyes.
14. OXYGEN HOOD
Plastic hood that can be placed over an infant’s head
It has an inlet which can be connected to the oxygen source
Front portion is chiselled such that it lies over infant’s neck while
allowing easy access.
Used to administer humified oxygen to infant in all conditions
associated with hypoxia
15.
16. ADVANTAGES:
non invasive
Allows humidification of oxygen
DISADVANTAGES:
Oxygen flow may be insufficient in cases where respiratory drive is
poor
Any change in the position of the hood may result in oxygen leaking
outside the hood thus decreasing oxygen concentration
Oral feeding is difficult
Poorly tolerated leading to excessive crying or struggling by the
child
18. • Spacers are bottle-shaped plastic devices
which have a mouth piece at one end and
other end has an opening which the MDI can
be attached.
19. • The disadvantage of MDI is that it requires
perfect co-ordination between inspiration and
activation of device.
• This may not possible in small children,to
eliminate this problem spacer is adviced.
20. How to use MDI with spacer device
• Remove the cap of MDI shake it and insert in
to spacer device.
• Place mouth piece of spacer in mouth or
attach to face mask in case of infants and
younger children
• Start breathing in and out gently and observe
movements of valve.
21. • Once breathing pattern is established press
canister and continue to breath 5-10 times
• Remove the device from mouth and wait for
30 seconds before repeating
22. Advantage
• MDI when used alone (withot spacer )rarely
deliver the full amount of inhailed medicines
to the lung (majority get deposited in
oropharynx)
thus, spacers should always be used along with
MDI’s to increase efficiency and decrease side
effects
25. • Nebulizers are devices which are useful in
delivering aerosolized drugs to lungs in
patients suffering from acute severe episodes
of asthma, bronchiolitis or status asthmaticus.
• They are especially helpful when when
inspiratory effort is weak as in case of
infants,prolonged episodes of asthma.
26. How to use nebulizer?
• Connect nebulizer to mains
• Connect output of compressor to nebulizer
chamber by the tubings provided with
nebulizer
• Put measured amount of drug in the nebulizer
chamber and normal saline to make it 2.5-3ml
27. • Switch on the compressor and look for aerosol
coming out from other end of nebulizer
• Attach facemask to this end of nebulizer
chamber and fit it to cover nose and mouth of
child
• Encourage child to take tidal breathing with
open mouth
28. Drugs which can be delivered to lungs
by nebulizer
• Bete -2 agonist – salbutamol
• Inhaled anticholinergics- Ipratropium Bromide
• Inhaled steroids- Budesonide
• Inhaled racemic epinephrine – in case of
bronchiolytis
• Inhaled chromolyn sodium- for maintanance
therapy of asthma.
29. • The commonly used nebulizer solution of
salbutamol contains 5mg of salbutamol per ml
of solution.
• The dosage of salbutamol is 0.15mg/kg/dose
• Amount should be diluted with about 2-3ml of
normal saline before nebulization.
31. • A tongue depressor is a device used in medical
practice to depress the tongue to allow for
examination of the mouth and throat
• They are usually made of stainless steel & can
be sterilized by autoclave,but nowerdays
disposable tongue depressors are available
which can be disposed off after use
• They are available in two shapes
33. uses
• To examine the gag reflex
• To examine the pharynx,oral cavity,tonsils
• To examine the movements of the palate &
the uvula
• Spatula test-to test for the spasm of the
masseter muscles in a suspected Tetanus case
by trying to insert the tongue depressor in
between teeth.
35. • CLINICAL THERMOMETER
2 types of thermometer are present
Axillary – for recording temperature in axilla
or the oral cavity
Rectal – the rectal thermometer has a stout
and a blunt bulb
36. • The clinical thermometer is calibrated over the range from
95-110 F
• Nowadays, digital thermometers of various types are
available. They provide quick results(45 seconds – 1 minute as
compared to traditional which take 3-5 mins)
• An even better device is available which when inserted into
the external auditory canal gives the temperature of
tympanic membrane (core body temperature) within a few
seconds.
• Disadvantage of this device is that it is difficult to use in case
of presence of wax and may accidently damage the ear .
37. • Uses –
• Used to record the body temperature
Hypothermia:
In premature infants
Infants with septicemia
In children with PEM
Hyperpyrexia:
In children with acute infections
In tetanus
Sunstroke
Pontine hemorrhage
• After use it should be washed with water and stored in a jar
partly filled with a chemical disinfectant like alcohol (70%)
38. • INFANT FEEDING TUBE
• It is a plastic tube with a blunt tip and opening on the lateral side close to
the tip
• The blunt end prevents damage to structures while introducing the tube
• It also has a radiopaque marker so that it can be easily visualised on x-ray
39. sizes
• Number 5 to number 12 are usually used in pediatric practice
Indications
• Diagnostic purposes
Diagnosis of internal bleeding in stomach and upper GIT
Diagnosis of TB
Diagnosis of tracheo-oesophageal fistula
Diagnosis of poisoning
Localisation of oesophageal strictures
Gastric analysis
40. • Therapeutic purposes
Nasogastric feeds
Management of haematemesis
Management of poisoning
Administration of drugs
Pre-operatively to decompress the stomach if an emergency surgery is to
be carried out and sufficient time for fasting is not available
• Other causes
As an oxygen catheter
For nasal , endotracheal and tracheostomy suction
As a tourniquet
41. PROCEDURE
• The approximate length that the tube should be inserted can be measured
by adding distance from the nose to the tragus to the distance from the
tragus to xiphoid. After inserting the tube and removing the stomach
contents via a syringe , the tube is fixed with the help of an adhesive tape.
42. SIMPLE RUBBER CATHETER
• It is made up of indian rubber with a blunt tip and opening on the lateral
side .
• The infant feeding tube can be used as a simple catheter in small infants
• Sterilised by autoclaving.
43. • SIZE OF CATHETER
• English scale- used in calibrating simple rubber catheter
diameter of the catheter= (number of catheter) + 2 /2
• French scale – used in calibrating foley’s catheter
1 french = 1/3 mm (diameter of catheter)
44. INDICATIONS
• URINARY CAUSES
Diagnostic
To differentiate between anuria and retention of urine
To collect sterile sample for urine culture
In procedures such as cystography and ascending pyelography
Diagnosis of hematuria
Diagnosis and localisations of strictures in the urethra
Therapeutic
To relieve acute retention of urine
To monitor the urine output in shock , renal failure
In case of paraplegia
To administer bladder wash
45. • NON- URINARY CAUSES
Bowel wash
To administer enema
To relieve flatus
As an oxygen catheter
For nasal/endotracheal suction/tracheostomy suction
As a tourniquet
PROCEDURE
After observing complete aseptic precautions (wash up – antiseptic cleaning
and draping of genital parts), the catheter tip is lubricated with lignocaine jelly
and slowly the catheter is guided into the urethra till drops of urine appear
from the distal end
46. COMPLICATIONS
Trauma – leading to bleeding and in chronic cases – stricture formation
Infection
Allergy to India rubber
Para – phimosis in cases of forcible retraction of prepuce while introducing
the catheter
