Why We Need Peds Practice, ‘Cheat Sheets,’ and Not Mental Math
We were between teaching sessions in Tokyo, Japan, when Lisa’s cell phone rang. It was an unbelievably emotional phone call from our nephew. He's a relatively new medic (three years) in a very rural area of the Midwest in which, in addition to several invaluable EMTs, he was the only paramedic on duty for his entire county. His late evening call to us involved his need to discuss/decompress/cry about a tragic pediatric call.
Quick summary of the case: Multi-vehicle accident in "the middle of nowhere” with extensive extrication required. The driver, the babysitter, was pronounced dead at the scene while an infant remained in their car seat and was mercifully uninjured. However, crucial to this case, a 10-year-old little girl, trapped in the back seat of the car, was critically injured. Our nephew had to climb through the broken back window of the SUV to begin treatment while she was still entrapped for “seemingly forever.” Shortly after extrication, this young child suffered the first of multiple traumatic arrests. She amazingly survived long enough for air transport to a pediatric trauma center at which she immediately underwent emergency surgery for head, chest, and abdominal injuries. Not surprisingly, after suffering several episodes of cardiac arrest, formal declaration of brain death was made a couple days later, followed by the multiple life-saving gift of organ donation.
However, the reason for this story is to relay a comment he made during our conversation. When he was intubating and resuscitating this 10-year-old multiple trauma patient on the side of the road, he told us two crucial things. First, “practice, practice, practice. At this moment, when everything was chaos, I fell back to the hours of practice that I’ve been doing with scenarios and peds procedures. Then, I grabbed my Broselow tape. It told me to use a 6.5 mm endo tube, 3.5 mLmL of epi, etc. So, that’s what I used.”
Wow. After over 25 years as pediatric emergency educators, in our humble opinion, that's why we highly recommend the Broselow tape, Handtevy app, Pedi-Wheel, etc. They allow healthcare professionals on the side of the road, in the ER, or wherever it may be, to not have to do "mental math" when a child's life is literally on the line.
Tapes, apps, wheels—they are out there. The math has already been done for you. The formulas have been figured out for you. Doing mental math under stress is simply stupid. Why would you do that? Find a pediatric “cheat sheet” you like and use it. Practice like your pediatric patient’s life depends on it. Your pediatric patients deserve nothing less!
