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10 Tips For Preparing For
Pediatric Office Emergencies
#1. The Office Self Assessment
• What type of emergencies do you
see? How often?
• Location, setting, resources?
• Staffing, training?
• Equipment, supplies, meds on
hand?
http://pediatrics.aappublications.org/cgi/reprint/120/1/200
#2. Essential equipment and
supplies
Equipment
• Oxygen-delivery system
• Bag-valve mask
• Suction
• Nebulizer
• Oropharyngeal airways
• Pulse oximeter
Supplies
• Cardiac arrest board
• Sphygmomanometer with
cuffs
• Splints, sterile dressings
Strongly Suggested
• Vascular access and fluid
management supplies
#3. Keep a card, chart or tape
handy
• Color-coded tape or
preprinted drug
doses
• Recognition works
better than memory
#4. Essential Medications
Essential
1.
Oxygen
2.
Albuterol for inhalation
3.
Epi 1:1000
Strongly recommended
• *Activated charcoal
• *Antibiotics
• Anticonvulsants - benzos
• Atropine
• Corticosteroids
• D5 0.45 NS
• *Dextrose 25%
• Diphenhydramine
• Epi 1:10,000
• Naloxone
• *Normal saline or Lactated Ringer’s
• Sodium bicarbonate 4.2%
#5. Maintain your
resuscitation skills
• In the setting of a pediatric
emergency, primary care
pediatric providers must be
able to provide basic airway
management and initiate
treatment of shock
• PALS and APLS are two
excellent courses to develop
and renew knowledge and
skills
#6. Train your staff with
CPR Anytime®
CPR Anytime® for children and
adults
#7. Recognize
emergencies early
Every person in the office should be trained to recognize
a potential emergency
• Extremely labored breathing
• Blue or pale color
• Noisy breathing
• Altered mental status
• Seizure
• Agitation (in the parent)
• Vomiting after a head injury
• Uncontrolled bleeding
#8. Have a plan to call for help
• Have a plan for arranging transport
– How
– Where
• The person arranging transport is responsible
for the safety of the patient
• Call ahead and talk to a doctor
#9. Translate research into
practice
•
Always use two person bag mask resuscitation
Davidovic et al. Annals Emerg Med. 2005;46:37-42
•
Early recognition, resuscitation and reversal of
septic shock in children makes a difference – it
improves outcome
Han YY, Carcillo JA, Dragotta M et al. Pediatrics.
2003;112;793-799
•
Therapy for shock should be initiated from the time
of diagnosis not transport
#10. Teach your patients
about emergencies
• Encourage first aid training and CPR training
for parents and caregivers
• Provide access numbers for after-hours advice,
emergency response system and poison control
• Teach your families about the symptoms and
situations where they should seek immediate
help
Summary
•
•
•
•
•
Perform an office self-assessment
Have essential equipment, supplies and meds on hand
Refresh and renew your skills
Use two person bag mask technique
Treat shock early, it improves outcome
For questions or comments e-mail me at
[email protected]