Differences of the Airway Between Adults & Children

In today’s micro-lecture, Australian Paramedical College Hon. Snr. Lecturer Sam Willis talks about the differences of the airway between adults and children.

In today’s micro lecture, we’re going to talk about the differences of the airway between adults and children. Now there are going to be occasions when you treat pediatric patients. The good news is, most patients you will treat will either be adult or elderly, mostly elderly. However, when you do treat pediatric patients, you do need to know a little bit about them. Because they’re not just small adults, they’ve actually got their own unique sets of physiology and psychology.

As they grow throughout the different ages, that physiology and psychology changes. So the purpose of this micro lecture is to provide a comparison between the adult and pediatric airways. Because actually every aspect is different between pediatrics and adults.

So let’s take a look at this simplified version of the upper airway. So here’s the child’s upper airway, here’s the adult’s upper airway. The first thing you notice, is in the child the tongue is much larger in proportion to the size of the mouth. What that means to you as paramedics is that the child is more likely to have an upper airway obstruction caused by the tongue. So you need to get used to using the smaller OP airways and doing the head tilt chin lift on a child.

However, you need to be careful when you do the head tilt chin lift because the cartilage in the trachea is much weaker than it is in an adult. So it’s not as well formed in a child as it is in an adult. You can actually hyper extend the airway and cause kinking. I always picture it like a toilet tube, when you’ve got the end of the toilet tube holder, and you kink it like that, that’s what I always think of when I’m tipping a child’s head back.

On many occasions, you just need to tape the airway open and don’t actually even need to tip the head back depending on the age of the child. So what you’ll also notice is the phalanx is much smaller as well. This is the passage down into the trachea, so the passage is much smaller. Meaning there’s a more likelihood risk of choking and obstruction and hypoxia. The epiglottis is larger and floppier, so in other words, the epiglottis that covers the trachea that stops anything apart from air going into the trachea, is actually larger and floppier, so let me show you that.

So here you have an adult epiglottis, which is just a fleck of cartilage. Here you have the vocal cords, and that’s the entrance to the trachea. Here’s the same one in a pediatric, much smaller and the actual epiglottis is actually what we call horseshoe shape, and it’s actually much larger as well. The narrowest point of the child’s airway is at the crico, so the cricothyroid. You have this larger opening and then it gets much narrower here and gets larger again. The trachea is relatively narrow and less rigid.

So we’ve already said that it’s less rigid because you can kink it like a toilet roll, but it’s also pretty narrow. Meaning that when you’re having to ventilate patients, you’re using a lot less oxygen and a lost less BVM.

So that’s a micro lecture of the differences between the adult and a pediatric airway.

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