Dr. Marianne Gausche-Hill
The guidelines now emphasize the use of capnography to monitor end-tidal CO2 to confirm endotracheal tube placement and assess the adequacy of CPR. With capnography, "you may see [return of spontaneous circulation] before you can even detect a pulse," she said.
Foreign body aspiration "is your worst nightmare in the ED because you know if you can’t get it out, the patient’s going to die. And we do know that kids just do this all the time," she said. More than 90% of patients with this condition are younger than 5 years. "You always begin with basic life support maneuvers if they’re still conscious. For the infant, it’s back blows and chest thrusts until the object is expelled or they become unconscious." For the conscious older child, start with the Heimlich maneuver. In unconscious children, progress to chest compressions; if the foreign body is esophageal, chest compressions may remove it.
If the foreign body is lodged deeper in the airway, use direct laryngoscopy and remove the object with Magill forceps in the pediatric size. Some recent surveys showed that "18% of EDs in the country do not have pediatric Magills. Look in your airway kit. Make sure you have them," she stressed.
Last, family presence during resuscitation attempts should be promoted, she said. Almost a dozen studies have shown that parents want that option and should be included in decision making when possible, she noted.
Dr. Gausche-Hill reported having no significant financial relationships to disclose.