Table 2 Pediatric airway management procedural skills checklist

#

Equipment Setup

Yes

No

1

BVM with O2 on at 10L (positioned on left)

2

10cm PEEP valve (positioned on left)

3

Oral and/or nasal airway (positioned on left)

4

Free flowing IV

5

Suction on: coming from right, positioned on right

6

ET tube-proper size for age with stylet (positioned on right)

7

Cuff checked: 10cc syringe attached

8

ETCO2 detector (positioned on left)

9

Laryngoscope handle and blade with light on: positioned on left

10

Difficult airway cart immediately available

#

Patient Positioning

Yes

No

1

Headboard off

2

Side rails down

3

Head positioned to align airway axis

4

Bed height appropriate

#

Pharmacology

Yes

No

1

Midazolam 0.05-0.1 mg/kg bolus or Fentanyl 1-2 μg/kg bolus ready or ketamine 1-2mg/kg AND Succinylcholine 1-2 mg/kg bolus or Rocuronium 0.6-1.2mg/kg bolus

2

Atropine or Epinephrine available

#

Intubation Steps

Yes

No

1

Put on personal protective equipment (gloves, mask, eye protection minimum)

2

Pre-oxygenation performed

3

Verbalize airway assessment

4

Intubator verbalizes explicit review of plan/back up with cutoffs

5

Induction agent given

6

Ability to ventilate considered/confirmed

7

Cricoid pressure applied (optional)

8

Neuromuscular agent given

9

Intubation technique appropriate

10

Intubator halts intubation efforts and initiates BVM if saturation decreases by 5% or <90%

11

Airway adjunct (oral/nasal) considered/employed if sat <90%

12

Intubation successful

13

ETT set at appropriate length for age at gum line (3x tube size in mm)

14

Placement confirmed with 2 indicators (positive ETCO2, breath sounds, O2 saturation)

15

Intubator does not let go of tube until it is secured