In both adults and children, abdominal distension (which may be massive in children) may be a sign of tension pneumothorax.
While cricoid pressure’s effectiveness at preventing passive regurgitation and aspiration during intubation is disputed, it may be effectively applied during bag-mask ventilation to prevent gastric insufflation of air in both adults and children.
The prevention of gastric inflation–a neglected benefit of cricoid pressure
Anaesth Intensive Care. 1988 May;16(2):139-43
The effect of cricoid pressure on preventing gastric insufflation in infants and children
Anesthesiology. 1993 Apr;78(4):652-6
A child with status epilepticus has been stabilised and intubated and is awaiting admission to the paediatric intensive care unit. You decide to insert a nasogastric tube. The nurse asks the following questions:
1. What size gastric tube would you like?
A four year old for example would usually need a tracheal tube size of 5.0mm internal diameter (age/4 +4), so would need a 10 Fr gastric tube.
2. To what length are you intending to insert it?
For neonates < 2 weeks and children >8 years 4 months a method called NEMU (nose-ear-midxiphoid-umbilicus measurement) may be used.
3. How will you confirm placement?
Further details on these measurements including positive and negative likelihood ratios of pH testing can be found in the evidence-based guideline from Cincinnati Children’s Hospital
A Sengstaken-Blakemore tube may be used to control post-partum haemorrhage by placing it in the uterus. More information in this post
After intubation it is critical to securely fasten the tracheal tube so it does not dislodge during transfer. Dedicated devices are available for this although mostly cloth tape is used.
Different knots have been compared although not found be significantly different in terms of security1. One favoured knot, which is easy to learn and to teach, is the lark’s head (also called cow’s hitch)2.
The tape is folded in half so there is a loop at one end and two free ends at the other. The loop is wrapped around the tube and the two free ends are fed through the loop, and then taped around the patient’s head. It has been suggested that this results in the tape gripping the tube over the widest possible area, thereby reducing the potential for slippage and displacement.
1.The insecure airway: a comparison of knots and commercial devices for securing endotracheal tubes
BMC Emerg Med. 2006 May 24;6:7 Open Access
2. A knotty problem resolved
Anaesthesia. 2007 Jun;62(6):637