At long last, after two years of writing (and rewriting), illustrating, and filming on-line videos, I’m excited to announce the publication of my new book Pediatric Airway Management: A Step-by-Step Guide, by Christine E. Whitten MD.
Anyone who rarely cares for children tends to be anxious when faced with a small child’s airway. This is true even if they are comfortable with adult airway management.
My goal for this book is to demystify basic pediatric airway management. I want to give you the skills you need to recognize when a child is in trouble and act quickly to safeguard that child, including helping them breathe if necessary.
Children are not miniature adults: in many ways normal pediatric anatomy and physiology make children more vulnerable to hypoxia, respiratory distress, and respiratory failure. Compared to adults, the leading cause of preventable death in pediatric emergencies – both medical and trauma – is failure to adequately manage the airway. Pediatric respiratory events carry a higher mortality than adult events (1).
I had my first introduction to just how different children are as a senior medical student on the anesthesia service — an elective that eventually proved life changing. My teacher had asked me what I wanted to do on the rotation and I had requested to take care of children. That resulted in a long pause in the conversation and a non-committal comment that we would just have see to how that went as the rotation progressed. Finally, on my last day my teacher assigned me to a room full of pediatric patients having either ear tube placement or tonsillectomies. Every child was a different age and every child seemed to have different anatomy. My teacher spent the day showing me how to adjust my newly acquired skills to each child. I left that rotation which deeper respect for the subtleties of pediatric airway management.
There is good reason why most providers are more nervous taking care of children, especially young children less than 2 years of age. From infants to toddlers to teenagers, the anatomy and physiology of the child is continuously changing. Managing the airway of a premature infant requires a slightly different technique than managing the airway of an older infant, a toddler, a child and a teenager. Not big differences, but enough to make care of the pediatric airway more challenging, especially for providers who care for children infrequently.
Fortunately, most children have easily managed airways. If you understand the differences, taking care of the typical pediatric airway is not difficult.
It’s a common trend to concentrate care of children in the hands of those who are more experienced. For example, anesthesia in young children is more frequently being done by pediatric anesthesiologists in children’s hospitals. While good in many ways, this trend deprives other providers of caring for children — making them less prepared for when they do have to care for a small child.
For those of you who rarely care for pediatric emergencies this book will teach you the anatomy, physiology and technical differences in recognizing respiratory distress, opening an airway, ventilating, and intubating infants and children. For those of you who routinely care for children, this book will share some of the tips and tricks I’ve learned for managing more challenging airways from 4 decades of practicing anesthesia.
Even if you don’t perform intubation yourself, chances are you will be assisting someone who does. Understanding how the techniques are performed will allow you to more effectively assist and improves the chance for a good outcome. Dosages, advantages and disadvantages of the different drugs for rapid sequence induction are also covered.
This book gives you step by step instructions on basic airway management guided by 267 illustrations and photos, plus over an hour of on-line video clips. These free video clips provide hours of footage of actual patients undergoing real surgical procedures, manikin demonstrations, and animations. The URL to my video page, which you’re welcome to use, is here.
The goal of Pediatric Airway Management is to give you a visual picture of airway management and intubation for each age of childhood. As you proceed through the book, use the video clips to picture yourself performing the steps. I hope my efforts make you confident in your ability to help children breathe. Anyone can learn how to to open an airway and ventilate a child.
My sincere wish is that this new book helps in the care of our littlest patients, no matter where they are.
May The Force Be With You!
Christine E. Whitten MD