The Leak Whistle

I can already tell that Children's Mercy is going to be a great rotation!  One of the interesting things I learned on my first day was how to check for a leak after intubating a pediatric patient.  As you know, after intubating a pediatric patient you need to check to make sure that there is a 15-20 cm H2O pressure leak.  No leak indicates an oversized tube that should be replaced to prevent postoperative edema and croup, while too much of a leak can prevent proper positive pressure ventilation.  After intubating and checking for breath sounds, put your stethoscope over the trachea right above the sternal notch.  As you slowly increase pressure using your APL valve, watch your pressure gauge and you will hear a very loud and distinct whistling sound when you have reached your leak pressure.  It is pretty cool.  Also, word of advice, make sure you have and always bring a stethoscope while on your pediatric rotation, you will finally be getting a lot of use out of it!