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Basic airway management in children
Author: Mark E Ralston, MD, MPH
Section Editor: Gary R Fleisher, MD
Deputy Editor: James F Wiley, II, MD, MPH
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Jun 2021. | This topic last updated: Jun 02, 2021.
INTRODUCTION
Basic airway management (including positioning to open the airway and positive pressure
ventilation with mouth-to-mouth and bag and mask) will be reviewed here.
The following related topics are discussed separately:
BACKGROUND
Effective airway support is an essential component of successful cardiopulmonary
resuscitation. Respiratory insufficiency leading to respiratory arrest typically precedes cardiac
arrest for most children. Survival rates between 43 and 82 percent have been reported for
®
Advanced airway management in children (see "Emergency endotracheal intubation in
children")
●
Basic life support in infants and children (see "Pediatric basic life support (BLS) for health
care providers")
●
The initial assessment and stabilization of critically ill or injured (see "Initial assessment
and stabilization of children with respiratory or circulatory compromise" and "Pediatric
advanced life support (PALS)")  
●
Basic airway management in adults (see "Basic airway management in adults")●
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children who have been resuscitated from respiratory arrest [1,2]. By contrast, between 4
and 14 percent of children who go on to develop cardiac arrest survive [1,3,4].
ANATOMIC CONSIDERATIONS
A clear, patent airway is a fundamental requirement for effective resuscitation. Anatomic
features that make the airways of infants and children more susceptible to obstruction and
that must be considered in order to maintain an adequate airway include the following (see
"Emergency airway management in children: Unique pediatric considerations", section on
'Anatomic considerations'):
NONINVASIVE RELIEF OF OBSTRUCTION
The head tilt-chin lift and/or jaw-thrust maneuvers should be performed to open the airway
in an unresponsive child before any more invasive airway adjuncts are utilized [5]. These
maneuvers place the airway in a neutral position and move the tongue and palatal tissues
away from the posterior wall of the pharynx. In-line immobilization of the cervical spine is
essential during these procedures if trauma is suspected. (See "Pediatric cervical spinal
motion restriction".)
The placement of an airway adjunct such as a nasopharyngeal or oral airway may be
The position of the larynx in infants and children is higher and more anterior than in
adults. As a result, hyperextension of the neck may worsen obstruction of the upper
airway.
●
Because the airways of children are smaller, they are more susceptible to obstruction
from edema, mucous plugs, or foreign body.
●
The relatively larger occiput causes passive flexion of the cervical spine in the supine
position, which contributes to a tendency for the posterior pharynx to buckle during
resuscitation. This can be prevented by maintaining the head in the sniffing position.
Placing a rolled towel under the child's occiput or upper shoulders may help to maintain
proper positioning.
●
A common cause of airway obstruction in the unresponsive child is the tongue, which is
relatively larger compared to the oral cavity in the child than in the adult and can fall
back against the hypopharynx in a child with a decreased level of consciousness.
●
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necessary if neither the chin-lift nor the jaw thrust maneuvers open the airway. The
indications and procedures for placement of these airways are discussed below. (See 'Airway
adjuncts' below.)
Head tilt-chin lift — In children who are suspected of having head or neck injuries, the
head-tilt-chin-lift maneuver should not be used prior to attempting to open the airway with a
jaw thrust [6]. (See 'Jaw thrust' below.)
To perform the head-tilt-chin lift technique, the fingers of one hand are placed under the
mandible, which is gently lifted upward to move the chin anteriorly. The thumb of the same
hand lightly depresses the lower lip to open the mouth. The thumb may also be placed
behind the lower incisors to gently lift the chin so that the lower central incisors are anterior
to the maxillary central incisors. One hand may be placed on the child's forehead to gently
tilt the head into a neutral position if there is no suspicion of neck injury ( figure 1 and
picture 1).
During the chin lift procedure, care must be taken to avoid closing the mouth, pushing on
the soft tissues under the chin, or hyperextending the neck [7] ( figure 2) because these
actions contribute to airway obstruction.
Jaw thrust — The jaw thrust is the preferred method for opening the airway when trauma is
suspected, in which case, cervical spine motion restriction should also be maintained. (See
"Pediatric cervical spinal motion restriction", section on 'Motion restriction during airway
management'.)
It is also useful for any patient when assisted ventilation with a bag-valve-mask is required.
(See 'Bag-mask ventilation' below.)
The jaw thrust maneuver is performed by grasping the angles of the lower jaw with one
hand on each side, and moving the mandible forward so that the lower central incisors are
anterior to the upper central incisors ( picture 2). If the jaw thrust alone does not restore
airway patency, a careful head tilt may be added [8,9].
Airway adjuncts — Oral and nasopharyngeal airways may be useful to improve ventilation,
particularly when oropharyngeal structures, such as the tongue, are obstructing the airway
[10,11].
Oral airway — An oral airway can be used in an unconscious child to lift the tongue and
pharyngeal soft tissues off of the posterior pharynx to maintain a patent airway ( picture 3)
[11]. Direct contact with the tongue and supraglottic structures may stimulate vomiting.
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An oral airway is optimally used as a bridge to recovery for a patient whose condition is
expected to be temporary (such as a child who is post-ictal or recovering from sedation).
However, prolonged tolerance of an oral airway usually suggests the need for endotracheal
(ET) intubation.
Selection of the appropriate size and careful placement are necessary to use this device
effectively and safely [11]. To choose the correctly sized oral airway, hold it along the side of
the child's face with the flange at the corner of the mouth. The tip of the airway should reach
the angle of the mandible ( picture 4). It should be inserted using a tongue depressor to
push the tongue to the floor of the mouth to avoid pushing the device into the base of the
tongue, thereby obstructing the child's airway.
Nasopharyngeal airway — A flexible nasal airway bypasses obstruction caused by the
tongue and pharyngeal soft tissues with minimal contact with the tongue [11]. It is much less
likely to induce emesis than an oral airway and is frequently tolerated by conscious patients.
Thus, this device is particularly useful for children with soft tissue upper airway obstruction
such as macroglossia or tonsillar hypertrophy, who have normal mentation and respiratory
function.
For nasal trumpets without an adjustable flange ( picture 5), the correctly sized nasal
airway is more accurately determined by the length of the device rather than by the bore.
The distance from the patient’s nostril to the tragus has been shown to correlate well with
the length from the nostril to the vocalcords in normal children and is our preferred method
for sizing [12]. Alternatively, the distance from the nostril to the mandible may be used.
However, the accuracy of this method has not been studied.
For nasal trumpets with an adjustable flange, the bore can be chosen to match the size of
the nares, and the cuff adjusted to the proper length. The bore should be large enough to
avoid obstruction by secretions but small enough to permit atraumatic passage and to avoid
pressure necrosis of the nasal mucosa.  
The nasal airway should be well-lubricated and gently inserted into the nostril to avoid
bleeding from injury to nasal mucosa or adenoidal tissue ( picture 6). The bevel of the
airway should face the nasal septum to minimize obstruction of the tip with nasal pharyngeal
mucosa.
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VENTILATION
Once the airway has been secured, if the child is not breathing spontaneously, the rescuer
should administer two breaths. Each breath should be given over one second [6]. Breaths
may be administered using mouth-to-mouth, mouth-to-mouth-and-nose, mouth-to-nose
techniques, or with bag-mask ventilation.
Chest compressions should also be initiated when there is no pulse or the heart rate is <60
beats per minute. Under these circumstances, one cycle of compressions should precede the
first breaths. (See "Pediatric basic life support (BLS) for health care providers", section on
'Basic life support approach'.)
General considerations — The following general principles should be applied no matter
which method of ventilation is used (see "Pediatric basic life support (BLS) for health care
providers", section on 'Breathing'):
Rescue breathing is performed while maintaining the airway with the chin lift or jaw
thrust. Only the jaw thrust maneuver should be performed in patients with head or neck
trauma.
●
The rescuer administers two slow breaths, delivering each breath over one second.
There should be a short pause between breaths to maximize oxygen content and
minimize carbon dioxide concentration in the delivered breaths .
●
The volume that is delivered should be sufficient to make the chest wall rise.●
Rescue breaths in perfusing patients who have inadequate breathing should be provided
every two to three seconds (20 to 30 breaths/minute).
●
During cardiopulmonary resuscitation, the timing of rescue breaths depends on whether
or not the trachea is intubated:
●
For lone rescuers, two ventilations should be delivered during a short pause at the
end of every 30 compression.
•
th
For two rescuers, two ventilations should be delivered at the end of every 15
compression.
• th
Once the trachea is intubated, ventilations and compressions can be performed
independently. For infants and children, ventilations are given at a rate of 20 to 30
•
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Rescue breathing, particularly if performed rapidly, may cause gastric distention. This can
interfere with effective rescue breathing by elevating the diaphragm and compromising lung
expansion. Gastric distention can be minimized by giving rescue breaths slowly, which allows
an effective tidal volume to be delivered at a lower inspiratory pressure [14]. When two
rescuers are present, cricoid pressure may be applied to compress the esophagus, thereby
reducing gastric distension. Evidence that compression of the esophagus decreases the risk
of regurgitation and aspiration is limited. Care must be taken not to obstruct the airway if the
technique is applied. (See "Rapid sequence intubation (RSI) outside the operating room in
children: Approach", section on 'External laryngeal manipulation (bimanual laryngoscopy)'.)
Mouth-to-mouth/nose — A barrier should be used for infection control whenever possible
during mouth-to mouth, mouth-to-mouth-and-nose, and mouth-to-nose breathing [6].
In mouth-to-mouth breathing (for victims older than one year of age), the rescuer takes a
deep breath and places his or her mouth over the victim's mouth to create a tight seal, while
pinching the victim's nose closed [6,11]. For victims younger than one year, the rescuer takes
a deep breath and places his or her mouth over the victim's mouth and nose.
Mouth-to-nose breathing is a reasonable alternative to mouth-to- mouth-and-nose breathing
for infants younger than one year of age. When the mouth-to-nose technique is used, it is
necessary for the rescuer to close the infant's mouth during rescue breathing.
Bag-mask ventilation — Health care providers who are properly trained can use a bag and
mask device to provide ventilation during pediatric resuscitation [6]. Furthermore, the use of
bag-mask ventilation rather than endotracheal intubation during cardiac arrest has been
associated with higher survival in children treated in both the prehospital and hospital
settings. (See "Pediatric basic life support (BLS) for health care providers", section on
'Epidemiology and survival' and "Pediatric considerations in prehospital care", section on
'Pediatric procedures'.)
Bag — Two types of ventilation bags are available, flow-inflating (anesthesia) or self-
inflating bags. The self-inflating bag is generally preferred for resuscitation. Advantages of
this device include the following:
breaths per minute. Compressions are delivered at a rate of 100 to 120 per minute
without pauses.
Coordination of compression and ventilation may be facilitated by counting
compressions aloud or using an audio-prompted rate guide [13].
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Unlike the flow-inflating bag, the self-inflating ventilation bag requires an oxygen reservoir
system to reliably deliver oxygen concentrations above 40 percent. This is because room air
is entrained in the system when the bag reinflates. With an oxygen flow rate of 15 L/min,
oxygen concentrations between 95 and 100 percent can be delivered using a 2.5 L bag
reservoir system [17]. Less oxygen is delivered at higher ventilation rates.
Self-inflating ventilation bags typically have a safety pop-off valve that reduces the risk of
barotrauma by limiting peak inspiratory pressures to between 35 and 45 cm H O. However,
higher levels of peak inspiratory pressure may be required to provide adequate tidal volume
and oxygenation when airway resistance is high or lung compliance is poor. In this situation,
the pop-off valve can usually be disabled [18]. Whenever possible, a manometer should be
used to monitor peak inspiratory pressure when the pop-off valve is disabled. Clinicians
should be familiar with the type of ventilation bags that are used in their facilities.
The ventilation bag should have a minimum volume of 450 to 500 mL, even for newly born
full-term infants [19-21].
Mask — Effective bag-mask ventilation requires a mask that fits properly. The correct size
is the smallest mask that completely covers the victim's mouth and nose without covering
the eyes or overlapping the chin ( picture 7) [11].
E-C clamp technique — The "E-C clamp technique" has been described by the American
Heart Association [6]. Utilizing this method, the rescuer can optimally position the airway to
deliver effective breaths, while applying the mask tightly to the victim's face to avoid air leaks
( picture 8). The technique is performed as follows [6]:
The self-inflating bag reinflates when it is released and does not require a gas source to
deliver breaths.
●
The self-inflating bag is easier to use. When compared to the flow-inflating bag, effective
bag-mask ventilation can be performed more reliably by health care providers with
variable levels of expertise using the self-inflating device [15,16].
●
2
Positioning of the child's head requires two maneuvers ( picture9):●
The neck is flexed forward on the shoulders, such that the external auditory canal is
anterior to the shoulder. This may be accomplished in children by placing a towel or
roll under the occiput. In infants, the towel must be placed under the shoulders to
achieve this position, because of a prominent occiput.
•
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For children with suspected injury to the cervical spine, positioning must be accomplished
without moving the neck. In-line manual stabilization must be maintained. (See "Pediatric
cervical spinal motion restriction", section on 'Motion restriction during airway
management'.)
Breaths are provided by using the other hand to compress the bag until the chest visibly
rises. The rescuer should use only the force and tidal volume required to make the chest rise.
For some patients, two rescuers may be required to provide effective ventilation (
picture 10). In this situation, one rescuer uses both hands (each hand in the "E-C"
configuration on either side of the face) to maintain the airway and hold the mask, while
another rescuer compresses the ventilation bag. The effectiveness of two-person, bag-mask
ventilation was demonstrated in a prospective observational study in which greater peak
pressures and mean tidal volumes per weight were generated in manikin models with two-
person, as compared with one-person, bag-mask ventilation [22].
MONITORING ADEQUACY OF VENTILATION
Chest motion should be constantly monitored as an indicator of the adequacy of ventilations.
It must be assumed that if there is no chest motion during CPR, there is no ventilation.
Possible reasons for impaired ventilation in a child without an artificial airway include [11]:
The head is then extended on the neck, such that the nose and mouth are pointing
toward the ceiling.
•
The mask is placed on the child's face, with the narrowest portion of the mask over the
bridge of the nose.
●
The little, ring, and middle fingers of one hand are then spread from the angle of the
mandible forward along the mandible forming the "E." These fingers lift the jaw, pulling
the face into the mask.
●
Finally, the thumb and forefinger of the same hand are placed over the top of the mask
in a "C" shape to squeeze it onto the face, forming a seal between the mask and the face.
●
A foreign body in the airway (see "Airway foreign bodies in children")●
Venting of a pop-off valve on the ventilation bag●
Inadequate pressure of ventilation●
Profound abdominal distension elevating the diaphragm and compromising lung●
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SOCIETY GUIDELINE LINKS
Links to society and government-sponsored guidelines from selected countries and regions
around the world are provided separately. (See "Society guideline links: Basic and advanced
cardiac life support in children" and "Society guideline links: Airway management in
children".)
SUMMARY AND RECOMMENDATIONS
expansion; placement of a nasogastric or orogastric tube can help to prevent this
complication
Bilateral pneumothoraces●
Respiratory insufficiency leading to respiratory arrest typically precedes cardiac arrest
for most children. Patients are much more likely to be successfully resuscitated from
respiratory arrest as compared with cardiac arrest. (See 'Background' above.)
●
Features of the pediatric airway make the airways of infants and children more
susceptible to obstruction and must be considered in order to maintain an adequate
airway. (See 'Anatomic considerations' above.)
●
Maneuvers to relieve airway obstruction include chin lift and jaw thrust ( figure 1 and
figure 3). Chin lift should not be used for patients with suspected cervical spine injury.
(See 'Noninvasive relief of obstruction' above.)
●
Oral and nasopharyngeal airways may be useful to improve ventilation, particularly
when oropharyngeal structures, such as the tongue, are obstructing the airway (
picture 4 and picture 5 and picture 6). Oral airways are appropriate for
unconscious patients. Nasopharyngeal airways are particularly useful for children with
soft tissue upper airway obstruction such as macroglossia or tonsillar hypertrophy, who
have normal mentation and respiratory function. (See 'Airway adjuncts' above.)
●
Once the airway has been opened, if the child is not breathing spontaneously, the
rescuer should administer two breaths. Each breath should be given over one second.
Breaths may be administered using mouth-to-mouth, mouth-to-mouth-and-nose,
mouth-to-nose techniques, or with bag-mask ventilation. Chest compressions should be
initiated when there is no pulse or the heart rate is <60 beats per minute. Under these
●
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ACKNOWLEDGMENT — The editorial staff at UpToDate would like to acknowledge Pamela
Bailey, MD, who contributed to an earlier version of this topic review.
Use of UpToDate is subject to the Subscription and License Agreement.
REFERENCES
1. López-Herce J, García C, Domínguez P, et al. Outcome of out-of-hospital
cardiorespiratory arrest in children. Pediatr Emerg Care 2005; 21:807.
2. Schindler MB, Bohn D, Cox PN, et al. Outcome of out-of-hospital cardiac or respiratory
arrest in children. N Engl J Med 1996; 335:1473.
3. Young KD, Gausche-Hill M, McClung CD, Lewis RJ. A prospective, population-based study
of the epidemiology and outcome of out-of-hospital pediatric cardiopulmonary arrest.
Pediatrics 2004; 114:157.
4. Herlitz J, Engdahl J, Svensson L, et al. Characteristics and outcome among children
suffering from out of hospital cardiac arrest in Sweden. Resuscitation 2005; 64:37.
5. Ludwig S, Lavelle JM. Resuscitation - Pediatric basic and advanced life support. In: Textbo
ok of Pediatric Emergency Medicine, 6th ed, Fleisher GR, Ludwig S, Henretig FM (Eds), W
circumstances, one cycle of compressions should precede the first breaths. (See
'Ventilation' above.)
Rescue breathing is performed while maintaining the airway with the chin lift or jaw
thrust. Only the jaw thrust maneuver should be performed in patients with head or neck
trauma. For patients in cardiac arrest, the ratio of ventilations to compressions varies
according to the number of rescuers and whether or not the trachea is intubated. (See
'General considerations' above.)
●
Ventilations should be delivered with sufficient pressure and volume to see the chest
wall rise. Hyperventilation and gastric extension can be minimized by delivering
ventilations slowly (over one second) and with only enough force and tidal volume
required to make the chest wall visibly rise. (See 'Ventilation' above.)
●
The E-C clamp technique is a useful method for bag-mask ventilation ( picture 8). (See
'Bag-mask ventilation' above.)
●
Poor chest wall movement suggests inadequate ventilation. (See 'Monitoring adequacy
of ventilation' above.)
●
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olters Kluwer | Lippincott, Williams & Wilkins, Philadelphia 2010. p.1.
6. Berg MD, Schexnayder SM, Chameides L, et al. Part 13: pediatric basic life support: 2010
American Heart Association Guidelines for Cardiopulmonary Resuscitation and
Emergency Cardiovascular Care. Circulation 2010; 122:S862.
7. Bhalala US, Hemani M, Shah M, et al. Defining Optimal Head-Tilt Position of
Resuscitation in Neonates and Young Infants Using Magnetic Resonance Imaging Data.
PLoS One 2016; 11:e0151789.
8. Pediatric Advanced Life Support Provider Manual, American Heart Association, Dallas 20
20.
9. Topjian AA, Raymond TT, Atkins D, et al. Part 4: Pediatric Basic and Advanced Life
Support: 2020 American Heart Association Guidelinesfor Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S469.
10. King BR, King C, Coates WC. Critical procedures. In: APLS: The Pediatric Emergency Medi
cine Resource, 4th, Gausche-Hill M, Fuchs S, Yamamoto L (Eds), Jones and Bartlett, Sudb
ury 2004. p.692.
11. Pediatric Advanced Life Support Provider Manual, Chameides L, Samson RA, Schexnayde
r SM, Hazinski MF (Eds), American Heart Association, Dallas 2012.
12. Roberts K, Whalley H, Bleetman A. The nasopharyngeal airway: dispelling myths and
establishing the facts. Emerg Med J 2005; 22:394.
13. Berg RA, Sanders AB, Milander M, et al. Efficacy of audio-prompted rate guidance in
improving resuscitator performance of cardiopulmonary resuscitation on children. Acad
Emerg Med 1994; 1:35.
14. Melker RJ. Asynchronous and other alternative methods of ventilation during CPR. Ann
Emerg Med 1984; 13:758.
15. Kanter RK. Evaluation of mask-bag ventilation in resuscitation of infants. Am J Dis Child
1987; 141:761.
16. Mondolfi AA, Grenier BM, Thompson JE, Bachur RG. Comparison of self-inflating bags
with anesthesia bags for bag-mask ventilation in the pediatric emergency department.
Pediatr Emerg Care 1997; 13:312.
17. Campbell TP, Stewart RD, Kaplan RM, et al. Oxygen enrichment of bag-valve-mask units
during positive-pressure ventilation: a comparison of various techniques. Ann Emerg
Med 1988; 17:232.
18. Hirschman AM, Kravath RE. Venting vs ventilating. A danger of manual resuscitation
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bags. Chest 1982; 82:369.
19. Terndrup TE, Kanter RK, Cherry RA. A comparison of infant ventilation methods
performed by prehospital personnel. Ann Emerg Med 1989; 18:607.
20. Field D, Milner AD, Hopkin IE. Efficiency of manual resuscitators at birth. Arch Dis Child
1986; 61:300.
21. Milner AD. Resuscitation at birth. Eur J Pediatr 1998; 157:524.
22. Davidovic L, LaCovey D, Pitetti RD. Comparison of 1- versus 2-person bag-valve-mask
techniques for manikin ventilation of infants and children. Ann Emerg Med 2005; 46:37.
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GRAPHICS
Head-tilt/chin-lift maneuver
One of the rescuer's hands is used to tilt the head, extending the neck. The index
finger of the rescuer's other hand lifts the mandible outward, raising the chin. Head tilt
should not be performed if cervical spine injury is suspected.
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Head-tilt/chin-lift maneuver
To relieve upper airway obstruction, the clinician uses two hands to extend the patient's neck. While one
hand applies downward pressure to the patient's forehead, the tips of the index and middle fingers of
the second hand lift the mandible at the chin, which lifts the tongue from the posterior pharynx. The
head-tilt/chin-lift maneuver may be used in any patient in whom cervical spine injury is NOT a concern.
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Airway changes with hyperextension
During the chin-lift procedure, care must be taken to avoid hyperextending the neck, which
may cause airway obstruction (arrow).
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Jaw-thrust maneuver
The jaw-thrust maneuver is used to relieve upper airway obstruction by moving the
tongue anteriorly with the mandible, minimizing the tongue's ability to obstruct the
airway. With the patient supine and the clinician standing at the head of the bed, the
technique is performed by placing the heels of both hands on the parieto-occipital
areas on each side of the patient's head, then grasping the angles of the mandible
with the index and long fingers, and displacing the jaw anteriorly. The jaw-thrust
maneuver may be used in the patient in whom cervical spine injury is a concern.
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Oropharyngeal airways
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Oropharyngeal airway sizing
A rough method for choosing the correct oropharyngeal airway (OPA) size is to hold the
airway beside the patient's mandible, orienting it with the flange at the patient's mouth
and the tip directed toward the angle of the mandible. The tip of an appropriately sized
OPA should just reach the angle of the patient's mandible.
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Nasopharyngeal airways
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Nasopharyngeal airway insertion
The nasopharyngeal airway (NPA) should be coated with water-soluble lubricant or anesthetic jelly. The
device is then inserted along the floor of the naris into the posterior pharynx behind the tongue.
Clinicians should note that the floor of the naris inclines in a caudad orientation approximately 15
degrees. The tube can be rotated slightly if resistance is encountered.
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Choosing the proper size pediatric mask
The correct size mask is the smallest size that completely covers the child's nose and mouth (photos
on left), without covering the eyes or overlapping the chin (photos on right).
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E-C clamp technique
The hand is positioned so that the little, ring, and middle fingers are spread over the
mandible from the angle of the jaw forward towards the chin in the configuration of
the letter "E". The jaw is then lifted, pulling the face into the mask. The thumb and
forefinger are placed over the mask in the shape of the letter "C". The mask is
squeezed onto the face and a seal is formed between the mask and the face.
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Proper positioning for ventilation and intubation for children
older than two years of age
(A) The oral (O), tracheal (T), and pharyngeal (P) axes are in divergent planes.
(B) A towel under the occiput brings the external auditory canal anterior to the
shoulder, aligning the T and P axes.
(C) The extension of the head on the neck, with the mouth and nose facing the ceiling,
aligns the O axis with the T and P axes.
Graphic 69636 Version 6.0
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Two rescuer bag-mask ventilation
Two rescuers may be necessary to provide ventilation. One rescuer may need both
hands to open the airway and make the seal between the child's face and the mask.
The second rescuer is then needed to provide positive pressure ventilation.
Graphic 72516 Version 5.0
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Jaw thrust maneuver
The rescuer uses two or three fingers of each hand to lift the jaw upward and outward
so that the lower central incisors are anterior to the upper central incisors. In children
with traumatic injuries, the cervical spine must be maintained in a neutral position
during this maneuver.
Graphic 53277 Version 2.0
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Contributor Disclosures
Mark E Ralston, MD, MPH Nothing to disclose Gary R Fleisher, MD Nothing to disclose James F
Wiley, II, MD, MPH Nothing to disclose
Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these
are addressed by vetting through a multi-level review process, and through requirements for
references to be provided to support the content. Appropriately referenced content is required of all
authors and must conform to UpToDate standards of evidence.
Conflict of interest policy
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