cruiseforever
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Is there anyone that has used this method to calculate medication doses for a ped's pt. I was exposed to it yesterday and it appears to be a quick, easy, and fairly accurate way to do it.
Handtevy for Peds.
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teedubbyaw
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I like how I just watched a 4min video that didn't tell me what it actually is.
And he talks funny.
And he talks funny.
COmedic17
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Yes. I use it and our medical director supports it. I have done several trial senarios and the handtevy dosages are very close to the dosage you would get if you used a math formula.
None the less, Prepare for a s***storm. Everyone is going to inform you that it's not accurate and you should never use an estimation based method for drug administration and will praise the broeslow tape. Then when you point out that the broeslow tape is a method using height to find estimated dosages for weight based drugs, they will become irate. Then a couple people will say they long hand med math for pediatric drugs, even in cardiac arrest cases.
And giving examples and showing the dosages provided by broeslow, handtevy, and long handed led-math showing how extremely close the handtevy method is to the long handed dosage won't help either. You will be deemed incompetent regardless of providing valid research backing your stance.
There's a thousand ways to skin a cat- unless your in EMS. Then there's only one way. And if your way is different then someone else's- your an incompetent idiot who is a disgrace to EMS.
None the less, Prepare for a s***storm. Everyone is going to inform you that it's not accurate and you should never use an estimation based method for drug administration and will praise the broeslow tape. Then when you point out that the broeslow tape is a method using height to find estimated dosages for weight based drugs, they will become irate. Then a couple people will say they long hand med math for pediatric drugs, even in cardiac arrest cases.
And giving examples and showing the dosages provided by broeslow, handtevy, and long handed led-math showing how extremely close the handtevy method is to the long handed dosage won't help either. You will be deemed incompetent regardless of providing valid research backing your stance.
There's a thousand ways to skin a cat- unless your in EMS. Then there's only one way. And if your way is different then someone else's- your an incompetent idiot who is a disgrace to EMS.
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COmedic17
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Oh, then they will bring up "well, what if drugs are packaged differently"...which applies to broeslow tape too.
Like on some versions of broeslow tapes, the EPI dose is really an ET tube dose...but it doesn't tell you that.
It's not an exact science, but it's gaining popularity and seems to work fairly well for most people.
For those wondering what it is-
Use this outline.
1yo = 10kg
2yo = 12kg
3yo = 15kg
4yo = 17kg
5yo = 20kg
6yo = 22kg
7yo = 25kg
8yo = 27kg
9yo = 30kg
Epi 1:10,000= Move decimal 1
Amio= Move decimal 1 over
Dfib= double weight 1&2nd dose
BiCarb= The weight
Dextrose = double weight
This tells you the exact ML to push, so you don't need to waste time figuring out the dosage per kg and the dosage in each ML.
So for example= a 3 year old.
3yo = 15kg
Epi dose= 1.5ml
Amio= 1.5ml
DFib- 30j, then 60j
BiCarb- 15
Dextrose (d25)- 30ml
Like on some versions of broeslow tapes, the EPI dose is really an ET tube dose...but it doesn't tell you that.
It's not an exact science, but it's gaining popularity and seems to work fairly well for most people.
For those wondering what it is-
Use this outline.
1yo = 10kg
2yo = 12kg
3yo = 15kg
4yo = 17kg
5yo = 20kg
6yo = 22kg
7yo = 25kg
8yo = 27kg
9yo = 30kg
Epi 1:10,000= Move decimal 1
Amio= Move decimal 1 over
Dfib= double weight 1&2nd dose
BiCarb= The weight
Dextrose = double weight
This tells you the exact ML to push, so you don't need to waste time figuring out the dosage per kg and the dosage in each ML.
So for example= a 3 year old.
3yo = 15kg
Epi dose= 1.5ml
Amio= 1.5ml
DFib- 30j, then 60j
BiCarb- 15
Dextrose (d25)- 30ml
COmedic17
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I'm feeling feisty today.
NomadicMedic
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COmedic17
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I'm just completing a spreadsheet for our service with all of our medications and their respective dosages for various pedi weights for inclusion in our protocols and to have laminated on the wall of the truck.
I was surprised to see how many common meds aren't on the Broslow tape, plain old MS or Dilaudid for pain control.
Granted they are speaking strictly code dosing, but thankfully the majority of peds I run aren't in arrest mode. Seems like a cool method, and if we're "estimating" any factor in the equation, the answer remains an estimate regardless of how exacting the remaining factors in the equation may be.
I'll shut up now....
Medicman
I was surprised to see how many common meds aren't on the Broslow tape, plain old MS or Dilaudid for pain control.
Granted they are speaking strictly code dosing, but thankfully the majority of peds I run aren't in arrest mode. Seems like a cool method, and if we're "estimating" any factor in the equation, the answer remains an estimate regardless of how exacting the remaining factors in the equation may be.
I'll shut up now....
Medicman
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This Handtevy method looks pretty cool. The haters need to think: any weight based-dose that is calculated based on anything other than an actual, recent weight is simply an estimate. Mom's recollection at what the kid weighed at the last doctor's appt, a length-based weight estimate like the Broselow tape, or your own estimate on how much they look like they weigh are probably not any closer on average than an age-based estimate. So I don't see how this Handtevy method is any less accurate than any of those methods.
That said, personally, I really think the way to go is to have pre-printed cards or sheets for each age that lists:
- the estimated weight for each age
- defib / cardioversion energy for that weight
- equipment sizes for that weight
- drug doses and, most importantly, drug VOLUMES for that weight - based on the concentrations that you carry, of course
That way all you have to do is pull out the card or turn to the page for the age of the kid, and you are DONE with figuring anything out.
The thing is, there really should be no thinking or calculations at all - even simple ones - required for these situations, because even simple methods are subject to be screwed up when you are cognitively overloaded, which happens when we get really stressed. Even as someone who does a fair amount of pediatric anesthesia and is very comfortable doing airway management and giving drugs to kids of all ages, I still don't want to have to figure anything out when the crap hits the fan.
This is a pretty good guide (I own it, but don't really use it just because I have my own reference that I typed up and keep with me), but it's also a good exercise to take the time to make your own: Pediatric Anesthesia And Emergency Drug Guide
That said, personally, I really think the way to go is to have pre-printed cards or sheets for each age that lists:
- the estimated weight for each age
- defib / cardioversion energy for that weight
- equipment sizes for that weight
- drug doses and, most importantly, drug VOLUMES for that weight - based on the concentrations that you carry, of course
That way all you have to do is pull out the card or turn to the page for the age of the kid, and you are DONE with figuring anything out.
The thing is, there really should be no thinking or calculations at all - even simple ones - required for these situations, because even simple methods are subject to be screwed up when you are cognitively overloaded, which happens when we get really stressed. Even as someone who does a fair amount of pediatric anesthesia and is very comfortable doing airway management and giving drugs to kids of all ages, I still don't want to have to figure anything out when the crap hits the fan.
This is a pretty good guide (I own it, but don't really use it just because I have my own reference that I typed up and keep with me), but it's also a good exercise to take the time to make your own: Pediatric Anesthesia And Emergency Drug Guide
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teedubbyaw
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You gonna make me one of those cards Remi? lol
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cruiseforever
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The Handytevy method was presented to us by Minneapolis Children's Hospital. They seemed covninced it was the way to go. They conducted a test with us to see if it makes a diffrence in getting proper doses of medication. Half of our group were given senarios based on our memory of dosages for peds. The other half was shown the Handtevy Method and then asked to take the test. Hopefully the will tell us how we did when the everybody goes thru the training sessions.
They also gave us hang tags for quick reference. It's half way down the page in the black box.
https://www.google.com/search?q=Handtevy+for+Peds&biw=922&bih=598&tbm=isch&tbo=u&source=univ&sa=X&ei=gb48VZzHNPK_sQSxxYGoCA&ved=0CEQQsAQ&dpr=1#imgrc=Tdk2siQq_WSjJM%3A;56lB3RduEu6i9M;https%3A%2F%2Fs-media-cache-ak0.pinimg.com%2F236x%2F16%2Fc0%2Fa2%2F16c0a20a5b795796248bf43c48ecec40.jpg;https%3A%2F%2Fwww.pinterest.com%2Felbertchu%2Femergency-medicine-foamed-foamcc%2F;236;177
They also gave us hang tags for quick reference. It's half way down the page in the black box.
https://www.google.com/search?q=Handtevy+for+Peds&biw=922&bih=598&tbm=isch&tbo=u&source=univ&sa=X&ei=gb48VZzHNPK_sQSxxYGoCA&ved=0CEQQsAQ&dpr=1#imgrc=Tdk2siQq_WSjJM%3A;56lB3RduEu6i9M;https%3A%2F%2Fs-media-cache-ak0.pinimg.com%2F236x%2F16%2Fc0%2Fa2%2F16c0a20a5b795796248bf43c48ecec40.jpg;https%3A%2F%2Fwww.pinterest.com%2Felbertchu%2Femergency-medicine-foamed-foamcc%2F;236;177
TomB
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I met Peter Antevy, M.D. and his wife Allison at EMS Today 2015 where he received an EMS 10 Award. He's a great guy. I also attended two of his classes.
I wrote about it here:
http://www.ems12lead.com/2015/02/28...finals-and-a-very-serious-topic-emstoday2015/
I put together a Pediatric Airway Chart that correlates Broselow color and age here:
https://twitter.com/EMS12Lead/status/591974751800791040
I'm evaluating the Handtevy system right now. We have one of the bags. Personally, I'm a believer! Jim Broselow, M.D. is a great guy. I had him on the EMS12Lead podcast where he talked about the Artemis Pediatric Initiative.
http://www.ems12lead.com/2012/08/10...mis-pediatric-initiative-ems-12-lead-podcast/
I wrote about Pediatric Pit Crew CPR here (much more primitive version of the airway chart):
http://www.ems12lead.com/2014/06/26/pediatric-pit-crew-cpr/
Whatever method you use be good at it! Our pediatric patients and their families deserve a high quality resuscitation attempt.
Tom
I wrote about it here:
http://www.ems12lead.com/2015/02/28...finals-and-a-very-serious-topic-emstoday2015/
I put together a Pediatric Airway Chart that correlates Broselow color and age here:
https://twitter.com/EMS12Lead/status/591974751800791040
I'm evaluating the Handtevy system right now. We have one of the bags. Personally, I'm a believer! Jim Broselow, M.D. is a great guy. I had him on the EMS12Lead podcast where he talked about the Artemis Pediatric Initiative.
http://www.ems12lead.com/2012/08/10...mis-pediatric-initiative-ems-12-lead-podcast/
I wrote about Pediatric Pit Crew CPR here (much more primitive version of the airway chart):
http://www.ems12lead.com/2014/06/26/pediatric-pit-crew-cpr/
Whatever method you use be good at it! Our pediatric patients and their families deserve a high quality resuscitation attempt.
Tom
gotbeerz001
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Guy at work made this.
Jwan
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now working on an pediatrics inpatient unit, I looked at the weights of a couple children admitted to our floor. Two 3yr old pts weighed 21.5kg, with a 6.5kg difference from what the handtevy method suggests would these children be recieiving an effective dose of whatever medication being administered in a pre hospital setting? (not a hater of the method just a question out of curiosity)
Jwan
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After looking at a few others theres a 15mo with a weight of 10.07 kg and a 5y.o. weighting 29.5kg, the younger is pretty darn close but that 5y.o. sits where a 9y.o. should according to this method
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cruiseforever
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Where would the pt. be with the Broselow tape? Just wondering how they compare.