PFC Podcast 278: Pediatric Airway Nightmares in Prolonged Field Care

In this high-yield, no-fluff episode, Dennis is joined by Dr. Michael Falk, a pediatric emergency medicine physician, former academic, and combat-experienced relief worker who has run airways in Haiti post-earthquake, Mosul during the ISIS fight, Ukraine, and Gaza. They break down exactly why pediatric airways are a completely different beast in prolonged field care and give you field-proven tactics that actually work when you’re the only one there with a BVM and a prayer.Key Takeaways You Can Use TomorrowPositioning is everything: One to two inches under the shoulders (or whole body) prevents automatic obstruction from the massive occiput.Adjuncts > early tube: NPA or OPA + side-lying (gravity is your friend) can keep you from tubing in the field.Tube sizing rule: Child’s pinky ≈ ET tube diameter. Depth = 3× tube size. Always go smaller — you can ventilate, you can’t un-damage a ripped airway.Intubation mindset: Kid airway is more anterior and cephalad. Slow down, work your way in, or you’ll be in the esophagus.GCS decision: <8–9 = tube. GCS 9+ with good positioning/NPA? Buy time and move.Sedation: Ketamine 0.5–1 mg/kg IV (post-tube). Longer acting, hemodynamically friendly.Ventilation: 20–30 breaths/min (one every 2–3 seconds). CO₂ buildup kills faster than low O₂.Fluids: 20 mL/kg NS/LR bolus, then 10 mL/kg blood. Push-pull technique with stopcock = fast.Shock recognition: Tachycardia + skin/mottling/mental status changes — they compensate until they don’t.Resource mindset: Permissive hypotension (>70 mmHg), conservative management, and don’t burn your whole blood bank on one patient.Chapters01:57 – Why kids crash so damn fast (high metabolic demand + tiny reserves)03:00 – The big-head/tiny-neck problem: Why laying a kid flat kills the airway05:10 – Shoulder elevation hack (T-shirt, plate carrier, demo pouch — anything works)06:59 – Gear reality check: What peds equipment should you actually carry?09:31 – Dosing apps that save lives (EM Stat / Stadia) + pinky rule for ET tubes12:01 – Go smaller, never bigger — and why13:12 – Croup physiology, floppy epiglottis, and dynamic airway collapse in trauma14:56 – The intubation trap: Your adult muscle memory will kill the kid17:12 – When to avoid intubation (GCS 9+ and supraglottic airways buy time)19:23 – Decision-making: Positioning → NPA/OPA → side-lying → tube22:32 – Oxygen vs. ventilation: CO₂ kills faster than hypoxia in kids25:35 – Supraglottic airways, King/Combi, and why cric is off-limits under ~10–1229:09 – Post-intubation sedation: Ketamine is king (0.5–1 mg/kg)32:28 – Ventilation goals, rates, and the “automatic BVM” vent limitations35:27 – Hypertonic saline hack for ICP and avoiding the tube39:42 – Circulation: Kids hide shock like pros (20 mL/kg crystalloid, 10 mL/kg blood)44:16 – Hypothermia, tourniquets (don’t fit), packing over tourniquets, and permissive hypotension48:50 – Monitoring traps: Adult cuffs lie, go analog (skin, pulses, cap refill, mental status)50:12 – Other peds trauma pearls (liver/spleen below ribs, no rib fractures = still bad chest injury)52:37 – Wrap-up & future deep-dive tease (peds chest trauma cases)For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠