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PAEDIATRIC ALTERED
CONSCIOUS LEVEL GUIDELINE |
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Round three
5. Airway assessment
Children with a reduced conscious level should be considered for intubation if:
(vi) their oxygen saturations are less than 92% despite high flow oxygen therapy and airway opening manoeuvres
|
Position |
Comment |
|
Renal |
Must avoid relying on oxygen saturation as a measure of ventilation when on supplemental oxygen. In high flow oxygen, sats can be in high 90s while hardly breathing and therefore hypercarbic. |
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paed |
I think ‘considered’ is the key word in this statement. Other factors ie clinical context, trend of conscious level to either improvement or deterioration should be taken into account in making final decision |
|
Paed ED |
Depends on any associated level of respiratory distress, also sometimes better to accept sats of 90-91% than to intubate depending on underlying cause |
|
PICU |
need to be thinking about CO2 too, ie measuring it and doing something about it |
|
ED |
Assuming no readily reversible cause for depressed level of consciousness (eg hypoglycaemia or opioid poisoning). |
|
Agreed |
Neither agree nor disagree |
Disagreed |
|
84% |
16% |
0% |
(ix) they have signs of shock despite resuscitating with fluid boluses totalling 40 ml / kg or more
|
Position |
Comment |
|
Endo |
I know this guideline doesn’t cover it, but we wouldn’t necessarily in DKA |
|
Agreed |
Neither agree nor disagree |
Disagreed |
|
92% |
8% |
0% |