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Frontline Consideration for Paediatric Emergency and Trauma Surgery
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Resuscitation of paediatric surgical patients presenting to the department should be carried out in a systematic fashion as laid out in the Paediatric Advanced Life Support and Advanced Trauma Life Support guidelines. As described above, there are discrete differences and potential pitfalls in managing infants and children. Resuscitation adjuncts such as the Broselow Tape system will allow clinicians to effectively estimate weight and age from the length of the presenting patient.
Emergency Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Alastair Brookes, Yiu-Che Chan, Rebecca Fish, Fung Joon Foo, Aisling Hogan, Thomas Konig, Aoife Lowery, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Colin Walsh, John Wang, Ting Hway Wong
An 8-year-old boy was hit by a car travelling at 35 miles per hour. He was thrown to the pavement and hit a tree. He was alert and oriented at the scene and complained of left upper abdominal pain. He is brought to the Emergency Department. How will you manage this child?Management is according to ATLS principles. Perform primary and then secondary survey and assess GCS (ABCs with C-spine control with simultaneous resuscitation), two cannulae should be inserted and bloods sent for FBC, U+Es, Glucose, urgent cross match and near patient coagulation tests.Acquire appropriate imaging that includes plain radiography, ultrasound and CT scan if indicated.Decreased GCS or suspicion of raised intracranial pressure or spinal injury warrants a CT scan of brain and spine as per the NICE guidelines and appropriate intervention or referral. If GCS < 8, child should be intubated and ventilatedCT scan of the abdomen and thorax with IV contrast is the gold standard investigation in a stable child following trauma.Broselow tape helps guide fluid and drug dosage.
Imaging
Published in Ian Greaves, Military Medicine in Iraq and Afghanistan, 2018
One of the early imaging changes was the introduction of a modified Baltimore dual-phase contrast bolus for trauma CT scans (Table 13.4). Conventionally, scans were performed during different arterial and portal venous phases following intravenous contrast administration. These scans required more planning by the radiographer, took longer to prepare and ultimately led to a higher radiation dose to the patient.17 The dual-phase continuous contrast injection allowed for a single acquisition of the torso (from base of skull down) starting at 70 seconds, which could continue through the lower extremities, providing angiography down to the feet if necessary.18 The torso enhancement of the arterial and portovenous system was good, whilst angiography was excellent. Such scope of scanning was not possible using the traditional contrast technique. This was further refined to provide a similar adapted protocol for paediatric patients. Defence radiology remains cognisant of paediatric radiation dose and the paediatric trauma protocols19; however, the same arguments apply with children often exposed to the same battlefield injuries and having a requirement for the whole body traumogram.20 Providing the clinicians, most of whom were not paediatric surgeons, with as much information as possible was the priority, and as such, whole-body CT was performed when justified.19 The dual-phase contrast bolus was adjusted for weight. This chart was originally colour coded to correspond with Broselow tape colours.
Development and Prospective Federal State-Wide Evaluation of a Device for Height-Based Dose Recommendations in Prehospital Pediatric Emergencies: A Simple Tool to Prevent Most Severe Drug Errors
Published in Prehospital Emergency Care, 2018
Jost Kaufmann, Bernhard Roth, Thomas Engelhardt, Alex Lechleuthner, Michael Laschat, Christoph Hadamitzky, Frank Wappler, Martin Hellmich
Several measures are available to reduce medication errors in pediatric emergencies with a reduction of cognitive input requirements to calculate drug doses as the main principle.11 Systems for length-based dosing recommendations have the advantage to combine the most reliable method to estimate a child's unknown weight12 with a reference for drug doses, estimated sizes for airway equipment and normal physiological values. The first device that offered such was the Broselow Pediatric Resuscitation System (known as “Broselow-Tape” (BT), Armstrong Medical Industries Inc., Lincolnshire, IL, USA) and has repeatedly been shown to have a positive impact on medication errors in simulated resuscitations.13 However, the only preclinical study published focused on an improvement of the rates within 20% dose deviations and mentions a not precisely reported reduction of tenfold errors.14 Nevertheless, such errors still occurred and difficulties in using this system have been described.15 Since the BT was never sold16 nor licensed as a medical product in Europe it was additionally unsuitable for its use in Europe. We therefore developed and introduced a certified and licensed length-based dosing recommendation system the “Pediatric emergency ruler” (PaedER; Alpha 1 e.K., Falkenberg, Germany) in 2008. Before the development, we determined the requirement on this device, that all information must be available directly on one spot and for administration of an adequate dose and volume of each drug, no further calculation steps arenecessary.
“Weighing Cam”: A New Mobile Application for Weight Estimation in Pediatric Resuscitation
Published in Prehospital Emergency Care, 2020
Joong Wan Park, Hyuksool Kwon, Jae Yun Jung, Yoo Jin Choi, Ji Soo Lee, Woo Sang Cho, Jung Chan Lee, Hee Chan Kim, Se Uk Lee, Young Ho Kwak, Do Kyun Kim
Because the Broselow tape can estimate weight only for pediatric patients up to 145 cm in height, we compared the weight estimated by the Weighing Cam with that estimated by the Broselow tape only when the pediatric patients’ measured height was under 145 cm. We constructed Bland-Altman plots with log-transformed data to evaluate the agreement between the weights estimated using the Weighing Cam and actual weights. Precision was evaluated by calculating the 95% limit of agreement (LOA) around the MPE. Statistical significance was defined as a P value less than 0.05.