Eh? Pedi field protocols?

  1. We have a new nurse orienting to the ER, never worked an ER before. She was asking me about RSI and I was explaining why we do it. The questions turned to intubating kids, and my coworker jumped in about how studies show that intubating kids actually does more harm than good, and that field protocols are now to bag kids and haul a$$ into the ER. Is this true? Our pedi codes always come in intubated but I'm wondering if that's because we're so rural that it often is just the medic and EMT on scene, whereas in town where the coworker works most of the time (he's per d. at my place) and there are pairs of hands coming out of the woodwork to help, it might be standard of care. Yes? No? I ask because while he is a very good nurse, he's also very arrogant and has been known to act more knowledgeable about something than he is.
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  2. 13 Comments

  3. by   andhow5
    I've never heard anything of the sort. I would think that a controlled airway would be the "golden rule" no matter peds, geri, et cetera...
  4. by   danh3190
    There seems to be some deemphasis on field intubation if the patient can be bagged well. Although intubation is the "gold standard", most paramedics just don't get enough practice, especially on kids, to be proficient. Although medics practice on manikins, it's just not the same. There's the problem of unrecognized esophageal intubation which can be fatal although as capnography spreads in the prehospital world it may provide faster recognition of improper tube placement or dislodged tube.
  5. by   traumaRUs
    I am a pre-hospital RN in IL, the focus is to bag kids - put an airway in, bag sparingly and come on in. The reason given is that:

    1. Intubating a child is technically difficult. This can result in a traumatic intubation and/or further airway compromise.

    2. Intubations with non-cuffed tubes almost always migrate and then you risk aspiration, airway compromise.

    3. Bagging a child or infant correctly (with an oral airway in place) is the preference for an airway.

    4. Unless the child goes out on you (witnessed arrest), we are calling far more codes in the field and just not transporting - especially if there is a prolonged down time or proloned transport time.
  6. by   TazziRN
    Thanks, TRU. Around here the kids almost have to be intubated because of lack of hands. Much safer for the kid to be tubed and have a first responder bag that, than worry about whether or not there is a proper seal, etc. This is due to the distance of a lot of transports, some of our stuff come in after an hour's transport.
  7. by   vamedic4
    3. Bagging a child or infant correctly (with an oral airway in place) is the preference for an airway.


    Don't forget about a nasal airway!! VERY useful in situations like these!!!

    And it's easy easy easy to do without having to worry about tube slippage and the complications that accompany it. As long as you can verify that you're doing a good job with bagging (via pulse ox/increase in HR) why risk intubation with all it's complications in transport??

    Just get a good seal and do it as if your own child's life depended on it. The right way.

    vamedic4
    prefers intubation but bagging works for me
  8. by   traumaRUs
    Why would you use a nasal airway in a child or infant? That would occlude the airway...the standard of care is an oral airway for a peds patient.

    I wanted to cite a source and couldn't find anything online. However, in my most-recent PEPP course (June 06), here is what the textbook says:

    "The value of performing ETT in children in the out-of-hospital setting is controversial. More studies are needed."

    In our system where we do have transport times of one hour or more (depending on the weather), we usually do not take the time to intubate.
  9. by   PedsER-RN
    Quote from tazzirn
    we have a new nurse orienting to the er, never worked an er before. she was asking me about rsi and i was explaining why we do it. the questions turned to intubating kids, and my coworker jumped in about how studies show that intubating kids actually does more harm than good, and that field protocols are now to bag kids and haul a$$ into the er. is this true? our pedi codes always come in intubated but i'm wondering if that's because we're so rural that it often is just the medic and emt on scene, whereas in town where the coworker works most of the time (he's per d. at my place) and there are pairs of hands coming out of the woodwork to help, it might be standard of care. yes? no? i ask because while he is a very good nurse, he's also very arrogant and has been known to act more knowledgeable about something than he is.
    so i guess if a kid has no airway, they just bag away and hope for the best? sounds like whoever told you that was talking out of their @ss. some of our transfers come intubated, and some scene calls do. if they come in and they're not, then we do it. sounds like they need a pals refresher.
  10. by   TazziRN
    Quote from pedser-rn
    so i guess if a kid has no airway, they just bag away and hope for the best? sounds like whoever told you that was talking out of their @ss. some of our transfers come intubated, and some scene calls do. if they come in and they're not, then we do it. sounds like they need a pals refresher.
    he's a good nurse but he tends to read things that say "studies suggest that..." and will pass it on as "studies proved that...." he was talking about field intubations, that babies and small kids should not be intubated in the field but wait till arrival in an er.

    he's pretty arrogant. he's a good nurse but thinks he's better than he really is. the attitude tends to come out when we have students and orientees around, which we've been overrun with this summer. he recently was hired by the ambulance company as a cct rn, so that's inflated things some.
  11. by   Pedi-ER-RN
    The director of our hospital pediatric transport unit (go to referring hospitals and pick kids up to bring back to PICU) says that if a kid goes bad on the way back and RT tries and doesn't get an ETT and we then try and don't succeed, just bag them. MUCH emphasis is placed on correct size mask and correct seal (this isn't anything new to us since all we work with are Peds).
  12. by   TazziRN
    Quote from Pedi-ER-RN
    The director of our hospital pediatric transport unit (go to referring hospitals and pick kids up to bring back to PICU) says that if a kid goes bad on the way back and RT tries and doesn't get an ETT and we then try and don't succeed, just bag them. MUCH emphasis is placed on correct size mask and correct seal (this isn't anything new to us since all we work with are Peds).
    Thanks, but my question was regarding filed pick-ups by EMS.
  13. by   Pedi-ER-RN
    Same theory when it comes to field transports. When they do classes for pre hospital personnell, the tell them the same they thing tell us.
  14. by   TazziRN
    Ah....okay, got it!

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