# PFC Podcast 278: Pediatric Airway Nightmares in Prolonged Field Care

Page: https://stenobird.com/podcast/prolonged-field-care-podcast-3929124/pfc-podcast-278-pediatric-airway-nightmares-in-prolonged-field-care
Text version: https://stenobird.com/podcast/prolonged-field-care-podcast-3929124/pfc-podcast-278-pediatric-airway-nightmares-in-prolonged-field-care.md
Podcast: [Prolonged Field Care Podcast](https://stenobird.com/podcast/prolonged-field-care-podcast-3929124)
Published: 2026-05-11T04:00:00+00:00
Episode link: https://podcasters.spotify.com/pod/show/dennis3211/episodes/PFC-Podcast-278-Pediatric-Airway-Nightmares-in-Prolonged-Field-Care-e3j4jq7
Audio file: https://traffic.megaphone.fm/APO2762480582.mp3
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JSON: https://stenobird.com/v1/public/podcasts/prolonged-field-care-podcast-3929124/episodes/pfc-podcast-278-pediatric-airway-nightmares-in-prolonged-field-care
Duration seconds: 3187

## Resource

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 Tomorrow Positioning 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. Chapters 01:57 – 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 th…

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