Learning Objectives

Overall Learning Objectives


1. Skills:

Achieve competence with mask ventilation. Gain experience with direct laryngoscopy, endotracheal intubation, and laryngeal mask airway placement.

2. Knowledge:

Learn (or reinforce) predictors of a difficult pediatric airway. Understand rapid sequence induction (RSI) and technique. Gain familiarity with commonly used sedatives and muscle relaxants.

3. Behaviors and Attitudes:

Reflect upon strengths and weaknesses of your own airway management skill set for continued improvement.

Specific Learning Objectives


  1. Basic pediatric airway assessment

  2. Recognition of anatomical features that predict difficult pediatric airways and the syndromes associated with these features

  3. Understand the anatomical and physiological differences between adult and pediatric airways

  4. Indication for intubation in pediatric patients

  5. Indication for placement of Laryngeal Mask Airways (LMA) in pediatric patients

  6. Indication for Rapid Sequence Intubation, including the selection of induction agents, the proper use of the technique and adequate application of cricoid pressure

  7. Understand basic Difficult Airway Algorithm

  8. Understand, recognize and know basic post-extubation complications and their management

  9. Develop basic pediatric airway management techniques which include:

a) Proper bag-mask airway management

b) Placement of oral airways

c) Placement of nasal airways

d) Placement of endotracheal tubes (ETTs), including indication for uncuffed versus cuffed ETT

e) Placement of laryngeal mask airways (LMA)

f) Assessment and confirmation of proper endotracheal tube placement

g) Recognition of failed intubation

Bellevue Airway Learner Guidelines (for Belleuve Team)

Authors: Kim Righter-Foss, CRNA and Shaun Mendel, CRNA

In light of the global impact of COVID-19 learners have less access to airway management opportunities. The Bellevue Surgery Center population and excellence in practice has created an opportunity to help our healthcare colleagues obtain their required airway management hours.

In a 2015 review of EMS calls, pediatric cases make up 7-13% of EMS responses, while 0.3% require intubation making pediatric DL or VL a low-volume high-risk procedure that can be improved with high fidelity simulation, psychomotor practice, and meaningful clinical learning experiences.1,2 As UW teaching associates and pediatric airway experts, this is an opportunity to increase the visibility of our knowledge and expertise.

Dr. Liston and Kate Uselman CRNA have tailored online learning modules for each learner prior to their arrival at BSC. As we expand with learners at the facility 5 days a week, there is a desire to clarify the expectations for disclosure and informed consent and how we will provide a consistent and equitable learning opportunity for the providers who will respond to in and out of hospital airway events.

Disclosure/Informed Consent

Seattle Children's Bellevue Surgical Center is part of the family of UW teaching hospitals and as such it is approved for learners. Our patients are deserving of informed consent, and it is the expectation that the airway attending will introduce the learner and inform the family they will assist in airway management. Families are able to refuse their assistance and the learner may observe or continue with simulation practice. Documentation in the medical record will be in the intubation note and should include what type of airway learner was present and that family consented to their role. If you have patient specific concerns that would exclude them from airway learning, please escalate concerns at morning huddle or with the airway attending.

Airway Education/Instruction

Practicing global airway management skills is the goal of the learners' time at BSC. This includes oral airway placement, mask management, LMA insertion, and direct and video laryngoscopy. The CRNA work flow will remain the same, selecting appropriate airway size and blade(s) for the patients. The CRNAs and the anesthesiologist facilitating the learner should collaborate at the beginning of the day to clarify who will be teaching and prompting the airway management in the room, although the primary responsibility is on the anesthesiologist assigned to the airway room. Each airway learner is allowed one attempt per patient, but this is at the discretion of the anesthesiologist. If the learner is not successful with the selected equipment, then the CRNA or anesthesiologist can demonstrate the appropriate exposure and intubation. If further teaching (manikin) is needed, then the anesthesiologist can assist as they are able to help with other OR duties. However, all providers are welcome and encouraged to facilitate airway instruction on the training simulator when time allows.

The collective pediatric airway knowledge at BSC is profound. As we grow in our educational scope we can meaningfully improve the airway safety and ability of providers, ultimately benefiting the children who depend on their ability to rescue.


1. Hansen, M., Lambert, W., Guise, J. M., Warden, C. R., Mann, N. C., & Wang, H. (2015). Out-of-hospital pediatric airway management in the United States. Resuscitation, 90 , 104–110.

https://doi.org/10.1016/j.resuscitation.2015.02.018

2. Sylvia Owusu-Ansah, Brian Moore, Manish I. Shah, Toni Gross, Kathleen Brown, Marianne Gausche-Hill, Katherine Remick, Kathleen Adelgais, Lara Rappaport, Sally Snow, Cynthia Wright-Johnson, Julie C. Leonard, John Lyng, Mary Fallat, COMMITTEE ON PEDIATRIC EMERGENCY MEDICINE, SECTION ON EMERGENCY MEDICINE, EMS SUBCOMMITTEE, SECTION ON SURGERY Pediatrics Dec 2019, e20193308; DOI: 10.1542/peds.2019-3308