Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

A Comment on A Pediatric Bag Separate From the Adult Gear

In reply to 9-ECHO-1 and to my post A Pediatric Bag Separate From the Adult Gear, was this comment from jim emt-p.

You all have made good points but you can not carry everything you could possibly need in one bag unless its the size of a truck.

Possibly need or practically need?

If we find that we need much more than is in the truck, we can call for help. We are supposed to do so early, to anticipate our needs, rather than wait until they are unavoidable and then panic, but there are some who do seem to love to create these panic situations. These are the adrenaline junkies. I am more of a relaxation junkie. I want to show up and calm everyone down, not make everything worse. I am not suggesting that jim emt-p is different from me, just pointing out that this is the SOP for some people.

There is a standard set of pediatric gear that is carried.

Airway gear that includes one, or more, pediatric laryngoscope handles. Redundancy is good, but we already should have at least one adult laryngoscope handle. If I have to give up one type of handle, I would give up the adult handle.

We tend to want to use the handle as a lever, to pull back on it like a slot machine arm. This is not good.

Using the adult laryngoscope handle with a pediatric laryngoscope blade might encourage us to apply adult leverage to the airway, even though we should not be using the laryngoscope as a lever. I would rather have people being more gentle with the adult airway, than more forceful with the pediatric airway. We tend to apply too much force to the adult airway to make up for not applying enough skill and understanding of the airway anatomy.

I would be comfortable with one adult and one pediatric laryngoscope handle in the intubation kit. If a second extra handle is needed, we can save weight by making it another pediatric handle. This might get some of us to understand what parts of our equipment are interchangeable.

Also in the airway kit would be a bunch of little OPAs (OroPharyngeal Airways) and NPAs (NasoPharyngeal Airways). They don’t take up much room and they weigh almost nothing.

We have a first in bag that has O2, trauma supplies, airway kit adult and pedi, AED, and BVM,

I would refer to that as an oxygen bag or an airway bag. Trauma supplies are similar to pediatric supplies. Both are light. So a bunch of bandages can make anything a trauma bag.

What about IVs?

Any time I am thinking about IVs with a trauma patient, I am considering giving medications, so I would want the rest of my drugs and not just an airway bag. Trauma patients tend to have a lot of pain. We can safely manage pain with a variety of medications.

then we have a med bag with all meds and IV supplies and a pedi wheel

I do not see the benefit of a pedi wheel.

Estimating Weight
In the out-of-hospital setting, a child’s weight is often unknown, and even experienced personnel may not be able to estimate it accurately.74 Tapes with precalculated doses printed at various patient lengths have been clinically validated74,77,95 and are more accurate than age-based or observer (parent or provider) estimate-based methods in the prediction of body weight.70–77 Body habitus may also be an important consideration.70,72,78,79
[1]

Unless we have an accurate weight, we are basing our calculation on a number that is probably wrong. GIGO Garbage In = Garbage Out. If it is important to calculate the dose correctly, and the child’s weight is an important part of that calculation, then the best way to come up with an accurate dose is to avoid entering a guess into the calculation. A length-based resuscitation tape is the recommended way to do that and I agree with that recommendation.

Endotracheal Tube Size
Length-based resuscitation tapes are helpful and more accurate than age-based formula estimates of endotracheal tube size for children up to approximately 35 kg,77,95,96 even for children with short stature.97
[2]

and we have a pedi bag. It is geared with equipment that is for pedis infants and neonate pt only. We have an OB kit in this bag also because most people forget that a preg. female can turn into multiple pts real quick.

How much of that pediatric gear is just duplicating adult gear and how much is unique pediatric gear that takes up significant space?

Very little extra space is needed for the pediatric gear. The pediatric gear takes up about the same amount of space as the OB (OBstetrical) kit. Not enough to need a separate bag.

We can work with 2 bags but three is a lot better.

That can be just a matter of personal preference, if we bring all of the bags with us on every call. The problem is that some people do not bring all of the ALS gear on every call. When working out of a fly car, that means that we cannot even go back to the car to get the gear until after we are returned to the scene, which may be several calls later. Some of these calls may be pediatric calls and if that pediatric gear is still in the fly car, what do we do for our pediatric patient with nothing but adult gear?

But I do agree that airway kits should cover all ages and med bags cover all ages.

If we already have most of the pediatric equipment with us, why not add the little bit of pediatric equipment that is not airway?

Even the IO (IntraOsseous) needles/gun are now part of the adult equipment. That leaves the pediatric doses of bicarb and dextrose, which we can make on out own out of the adult containers by eliminating half of the contents and replacing with saline out of an IV bag. Instant half strength medication. Not instant, but not that much longer. If i cannot measure half of a pre-filled syringe, than I should not be giving medications to any pediatric patients.

Now that said to help keep from getting caught in a bad situations, expect the worst on every run.

I agree.

Footnotes:

[1] Estimating Weight
2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science
Part 14: Pediatric Advanced Life Support
Emergency Fluids and Medications
Free Full Text from AHA with link to Free Full Text PDF

[2] Endotracheal Tube Size
2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science
Part 14: Pediatric Advanced Life Support
BLS Considerations During PALS
Free Full Text from AHA with link to Free Full Text PDF

Comments

  1. Our peds bag is almost universally BLS equipment, except for an IV kt (no fluids or sets except for a flush/lock, assumption being that the full-first in bag with those items also goes in on every call anyway). OPAs and NPAs (which are repeated in the primary first-in bag), pedi/infant BP cuffs, pedi stethoscope, Pedi/infant O2 masks and cannulas, and a pedi/infant BVMs. No drugs in the pedi bag, and only BLS meds in the first-in bag. OB kits stay in the truck. Wound care items round out the peds bag.

    All the ETI stuff stays with the ETI kit in the primary bag. The one weakness I see is the Broslow being in the pedi bag. I’d honestly rather have it in the drug box.

    Since our ALS/BLS staffing varies by shift, we don’t have an ALS bag. We just have a bag with a little of column A and a little of column B; it weighs about 30 pounds and has no room left for anything.

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