Guidelines for paediatric emergency equipment and supplies for a physician s office

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1 Guidelines for paediatric emergency equipment and supplies for a physician s office Peer review and other recent paediatric literature have suggested that office-based physicians who care for children should have some basic emergency care equipment, supplies and drugs available to deal with the occasional life-threatening situation that might occur in the office setting. The recommended equipment, supplies and drugs are considered optimal to support a child until his or her arrival in the hospital emergency department. The choice of exactly what to obtain depends on the type of practice and the location of the office. For example, a physician whose office is farther than 30 minutes from a hospital may stock more of the desirable items. If a basic package of emergency equipment is not available, some medicolegal problems may arise. All physicians caring for children should be knowledgeable and up-to-date in paediatric cardiopulmonary resuscitation. The Canadian Paediatric Society recommends that the materials listed in the tables below be stocked in physicians offices. All drugs should be kept in a locked emergency equipment container, and their expiry dates reviewed regularly. The total cost of these supplies is less than $1,000. TABLE 1: Circulation supplies recommended for physicians offices Vascular access Intravenous butterfly needles (25, 23, 21 gauge) Indwelling intravenous catheters (24 to 18 gauge) Intravenous fluids and tubing Normal saline (two 500 ml bags) Normal saline in 5% dextrose (two 500 ml bags) Extension tubing Drip chambers (Solusets) Syringes (1 cc, 5 cc, 10 cc) with needles Tape Tourniquet (rubber bands, tubing) Sphygmomanometer (with assorted cuffs) T-connectors Arm boards Intraosseous needles (16 gauge) TABLE 2: Emergency drugs recommended for physicians offices Epinephrine for anaphylaxis (1:10,000 solution: 0.1 ml/kg)

2 (1:1000 solution: 0.01 ml/kg) Diazepam (0.1 mg/kg every 5 mins, maximum 0.3 mg/kg intravenous or 0.5 mg/kg rectally [maximum10 mg/]) or Lorazepam (0.1 mg/kg intramuscular or intravenous) Dextrose (25%: 1 to 2 ml/kg and 10%: 2.5 to 5 ml/kg) Salbutamol aerosol, three to six puffs Dosing cards or tapes Salbutamol solution for nebulization (0.03 ml/kg maximum 1 ml) Salbutamol nebules of 2.5 mls: < 10 kg: 2,5 mg > 10 kg: 5 mg Epinephrine (1:1,000): in nebulization for airway compromise (eg, croup) 0 to 10 kg 2.5 ml, 10 kg 5.0 ml Or racemic epinephrine: 0 to 10 kg, 0.25 mg; 10 kg, 0.5 mg Optional Sodium bicarbonate (full and half-strength) 1 to 2 meq/kg intravenous Naloxone (0.1 mg/kg to maximum of 2.0 mg intravenous or intramuscular) TABLE 3: Trauma and miscellaneous supplies recommended for physicians offices Nasogastric tubes (10, 16) French Emergency equipment container (cart box) Emergency phone list (police, hospital, etc) Latex-free gloves Dressings, bandages, splints Steristrips Pulse oximeter TABLE 4: Airway supplies recommended for physicians offices Bag-valve-mask (self-inflating with reservoir) Paediatric volume 100 to 700 ml Adult volume 700 to 1000 ml Oxygen masks (adult, child, infant) Oxygen tank and valve with flowmeter Oxygen tubing Spacer device for aerosolized medication (adult, infant)

3 Laryngoscope and blades with endotracheal tubes (various sizes) or Laryngeal airway masks (various sizes), the choice depending on the level of expertise Suction machine and catheters Suction tips (Yankauer) Compressor with nebulizer and mask Optional Nasal cannulae References 1. Altieri M, Bellet J, Scott H. Preparedness for pediatric emergencies encountered in the practitioner s office. Pediatrics 1990;85: American Academy of Pediatrics, Committee on Drugs. Emergency drug s for infants and children. Pediatrics 1988;81: Birenbaum R. CMA call for emergency kits in doctors offices spurs debate. Can Med Assoc J 1991;145: Fuchs S, Jaffe DM, Christoffel KK. Pediatric emergencies in office practices: prevalence and office preparedness. Pediatrics 1989;83: Hodge D. Pediatric emergency office equipment. Pediatr Emerg Care 1988;4: Holler A, Johnson C, Luten R, et al, eds. APLS: The Pediatric Medical Course, revised edition. Elk Grove Village: American Academy of Pediatrics, Dallas, Texas, American College of Physicians, Sapien R, Hodge D. Equipping and preparing the office for emergencies. Pediatr Annu 1990;19: Seidel J. Preparing for Pediatric Emergencies. Pediatr Rev 1995;16: ข อม ลจาก Guidelines for paediatric emergency equipment and supplies for a physician s office Community Paediatrics Committee, Canadian Paediatric Society (CPS) Paediatrics & Child Health 1999; 4(3): Reference No. CP98-05 (http://www.cps.ca/english/statements/cp/cp98-05.htm) และย งม อ กค อ Resuscitation, Airway Management, and Acute Arrhythmias: Table 1-3: Drug Doses For Pediatric Resuscitation Mark A. Graber, MD Departments of Family Medicine and Emergency Medicine

4 University of Iowa College of Medicine Peer Review Status: Externally Peer Reviewed by Mosby Table 1-3: Drug Doses For Pediatric Resuscitation Drug Dose Remarks Adenosine 0.1 to 0.2 mg/kg. Maximum single does: 12 mg Atropine sulfate Bretylium toslyate Calcium chloride 10% Dopamine hydrocloride * Dopamine hydochloride * Epinephrine for bradycardia Epinephrine for asystolic or pulseles arrest 0.02 mg/kg per 5 mg/kg; may be increase to 10 mg/kg per 20 mg/kg per Rapid IV bolus. Minimum : 0.1 mg. Maximum single : 0.5 mg in child, 1.0 mg in adolescent. Rabid IV. Give slowly mg/kg/min Titrate to desired effect µg/kg/min Adrenergic action dominates at > µg/kg/min. IV/IO: 0.01 mg/kg 1:10,000 ET: 0.1 mg/kg 1:10,000 First : IV/IO: 0.01 mg/kg 1:10,000. ET: 0.1 mg/kg (1:1,000) = 0.1 1:1,000. Doses as high Be aware of effective of preservatives administered (if preservatives are present in epinephrine preparation) when high s are used. Be aware of effective of preservative administered (if preservatives prsent in epinephrine preparation) when high s are used.

5 Epinephrine infusion Lidocaine Lidocaine infusion Sodium bicarbonate as 0.2 mg/kg may be effective. Subsequent s: IV/IO/ET: 0.1 mg/kg (1:1000) = 0.1 1:1000. Doses as high as 0.2 mg/kg may be effective Initial at 0.1 µg/kg/min. Higher infusion used if asystole present. 1 mg/kg per µg/kg/min 1mEq/kg per or 0.3 x kg x base deficit Titrate to desired effect ( µg/kg/min). Infuse slowly and only if ventilation is adequaqte. From JAMA 268:16, IV, Intravenous, IO, intraosseous, ET, endotracheal. * Run these drugs in rapidly at first to clear the line and ensure drug delivery. When note clinical response (increase in heart rate, blood pressure), decrease drip rate to desired infusion rate. Defibrilation: Energy = 2 J/kg. If this not effective, use 4 /kg = 2.<BR> Dilutions: For dopamine and dobutamine: 6 x body weight (kg) = # of mg in 100 ml D 5 W then 1 ml/hr = 1.0 µg/kg/min. ข อม ลจาก e/1-3.html

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