Organizing the hospital for pediatric trauma care
David E. Wesson, Bindi Naik-Mathuria in Pediatric Trauma, 2017
Given the larger variety of equipment required for care of the injured child compared with an adult, careful organization of the trauma resuscitation area is paramount. Equipment should be easily accessible, clearly labeled, and safely and logically organized. One method of organizing the resuscitation area for pediatrics is the Broselow system. This system supplies the practitioner with information and equipment in an age-specific manner, all contained in a color-coded cart [20]. In addition, the Broselow tape is a rapid method of determining the child’s weight based on height. A standard method for estimating weight in kilograms should be used (e.g., length-based system) for children who require resuscitation or emergency stabilization. Early calculation of a child’s weight allows appropriate calculation of emergency medications, IV fluid boluses, and blood products. Pre-calculated dosing guidelines for children of all ages should be developed and easily accessible during a pediatric resuscitation. Sedation and analgesia for specific procedures need to be incorporated into pediatric preparedness. Staff should be continually educated and knowledgeable about what is in the Broselow cart or where all pediatric equipment is located. Inability to locate age/size-appropriate equipment at the time of pediatric trauma resuscitation can have a significant negative impact on outcome.
Emergency Surgery
Tjun Tang, Elizabeth O'Riordan, Stewart Walsh in Cracking the Intercollegiate General Surgery FRCS Viva, 2020
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
Ian Greaves in 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.
“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
Therefore, there have been many studies on various methods of accurately estimating the body weight of pediatric patients using observer (parent or healthcare provider) estimates (4–8), age-dependent formulae (9–12), length-based tapes with precalculated doses (i.e. Broselow Pediatric Emergency Tape) (3), and methods based on humeral length and mid-arm circumference (13). Among these methods, the Broselow tape is widely used worldwide as a weight estimation method. The Broselow tape has been clinically validated and has been shown to be more accurate than age-based formulae and healthcare provider estimates (14). However, the Broselow method requires a measuring tool that costs approximately $25 and cannot be used for pediatric patients taller than the tape. Additionally, the Broselow tape is based on data from US pediatric patients and tends to overestimate or underestimate the actual weight in pediatric patients from other countries (15–17). Additionally, the Broselow tape does not estimate weight as accurately as the newer length and habitus combined systems, such as the PAWPER tape (14, 18–20).
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.
A Standardized Formulary to Reduce Pediatric Medication Dosing Errors: A Mixed Methods Study
Published in Prehospital Emergency Care, 2022
Nichole Bosson, Amy H. Kaji, Marianne Gausche-Hill
Since 2001, paramedics in LA County use a length-based resuscitation tape (e.g., Broselow Tape) to estimate the weight of a pediatric patient, and refer to the MCG LA Color Code Drug Doses, previously known as “LA Kids” (12), to determine the correct dose for all weight-based medications including midazolam, based on the patient’s identified color code (21). The LA Color Code Drug Doses is specific to the LA County paramedic scope of practice and formulary; paramedics do not use the length-based resuscitation tape to reference any medication dosing or device size. If the patient is longer than the length-based resuscitation tape, then they are treated with 5 mg, per adult dosing protocols. Prior to February 2017, the medication doses were given in milligrams on the MCG, and the volume of administration was calculated by the paramedic based on the formulation of the medication. Since the change to the MCG with the standardized formulary with a single concentration for each medication, the LA Color Code Drug Doses lists all doses in both milligrams and milliliters, such that paramedics reference the Color Code Drug Doses for both pediatric and adult patients to directly determine the volume of medication to draw up and administer to the patient (Figure 1). Paramedics access the Color Code Drug Doses via a link on their documentation tablets. It is also available in printed format on most paramedic units, but this varies by Provider Agency.
Related Knowledge Centers
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- Percentile
- Dose
- Medical Device
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- National Health & Nutrition Examination Survey
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