# Handtevy for Peds.



## cruiseforever (Apr 24, 2015)

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.


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## STXmedic (Apr 24, 2015)

@COmedic17


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## teedubbyaw (Apr 24, 2015)

I like how I just watched a 4min video that didn't tell me what it actually is.

And he talks funny.


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## COmedic17 (Apr 24, 2015)

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.


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## luke_31 (Apr 24, 2015)

Would love to know how it works.  Definitely could use something more efficient than the broslow tape which isn't always readily available.


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## STXmedic (Apr 24, 2015)




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## COmedic17 (Apr 24, 2015)

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


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## COmedic17 (Apr 24, 2015)

STXmedic said:


> View attachment 1997


I'm feeling feisty today.


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## NomadicMedic (Apr 24, 2015)




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## COmedic17 (Apr 24, 2015)




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## MedicMan (Apr 25, 2015)

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


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## Carlos Danger (Apr 25, 2015)

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


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## teedubbyaw (Apr 25, 2015)

You gonna make me one of those cards Remi? lol


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## MedicMan (Apr 25, 2015)

Have to agree that mind math on the tail end of a double , with an apneic 4 y/o is really challenging.... Even (if not especially) after 25 years in the business, it is  the most intimidating prospect in our business,  at least to me...


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## cruiseforever (Apr 26, 2015)

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


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## TomB (Apr 26, 2015)

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


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## gotbeerz001 (Apr 27, 2015)

Guy at work made this.


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## Jwan (Apr 27, 2015)

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)


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## Jwan (Apr 27, 2015)

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 (Apr 28, 2015)

Jwan said:


> 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


 
Where would the pt. be with the Broselow tape?  Just wondering how they compare.


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## TomB (Apr 28, 2015)

Most pediatric drugs (not all) are dosed according to lean body mass which is why length based and age based estimations are acceptable (and comparable). Dr. Broselow says it's acceptable to "bump up a color" if the child is large for his/her age. But, considering that so many kids are not getting their first dose of epinephrine in cardiac arrest, "close enough" is a heck of a lot better than nothing! Pediatric epi pens, for example, are not weight based at all. We want to get a therapeutic, non-toxic life-saving dose on board.


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## PBavaro (Apr 28, 2015)

I currently work with Dr. Antevy and with Pediatric Emergency Standards. Quick background on myself, I am a FF/PM down here in S. Florida and have used both the Broselow System and the Handtevy System. The majority of departments down here including City of Miami, Miami-Dade, Disney, Orlando, Coral Springs, etc. have all made the change to the Handtevy.  

Just so you all are a little more aquatinted with the system and the Handtevy Method (The hand with 1,3,5,7,9) I'm going to highlight a few keys points of the System.

1. The Handtevy System is an age based hybrid system. It allows for determine a child's weights based on the age of the patient prior to arriving on scene. Therefore treatment of the patient can begin prior to arriving. For those of you using Broselow, you have to first arrive on scene to measure the patient in order to even begin treating the patient. Knowing what treatment you need to give in route to the call lowers the anxiety and "oh crap" level pediatric emergencies bring with them. This allows for a clearer mind and better treatment. Right now, only 34% (references for this number available upon request) of pediatrics receive epinephrine in the field. Why? Because we have a developed a load and go mentality when it comes to a pediatric emergency such as a drowning. The average time on scene with a pediatric emergency is 7 minutes compared to an adult emergency which on average is 20 minutes (references available upon request)

2. The Handtevy System is customized to your departments protocols. Someone here mentioned that "what if your medication concentrations are different?". Every single medication, concentration, airway size (Kings, LMA, OPAs, ET Tubes) that your protocols call for are all dosed in the mL form or sized for you in your customized medication guides. So in essence all you would do is flip to age 3 for instance and pick whichever medication you need that you carry on your trucks and it is dosed for you. This eliminates all aspects of math for you.

3. I always get this questions so I am going to address it now. "What if you have a patient who's too tall or too short for their age and you figure that out once you get on scene?". PALs guidelines has pediatric emergencies being treated with a LBT. That being said, we also have a color coded LBT for circumstances such as these. In fact our tapes go all the way up to age 13. Most children will not hit puberty until around the age of 13. For this reason Dr. Antevy felt that children who have not hit puberty should not be receiving adult doses of medication. 

4. After implementing many agencies across the country we conducted a study on the discordance between the Broselow Tape and the protocols of these agencies. The majority of agencies had a 50% discordance between medications found on the tape and medications in their protocols. I am attaching one of these studies done on Denver Paramedics who have implemented the Handtevy System. The attached file is actually a page from their customized medication books. Xs indicate medications not found on the Broselow Tape or medications that were not the correct doses. There was over a 58% discordance. 

Again these are just a FEW of the highlights of the Handtevy System. If you have questions or want to learn more about the Handtevy System send me a message. I am happy to help educate.


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## PBavaro (Apr 28, 2015)

luke_31 said:


> Would love to know how it works.  Definitely could use something more efficient than the broslow tape which isn't always readily available.




Luke, send me an email. Pbavaro@handtevy.com I would love to teach you about the system.


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## Handsome Robb (Apr 29, 2015)

@PBavaro I'm very interested in this. I haven't had a chance to look at it in depth but from what I've seen I really like it. 

Would love to talk to you more about it and what it takes to implement it at an agency as far as the process and any evidence/studies you have supporting its use as well as the discordance from the Broselow tape you noted.

I actually brought up your method in my PALS recert today but didn't dive too deep into it because I frankly don't know enough and neither of the instructors nor any of my classmates had heard of it. Granted my class had 3 PRN RRTs from a small hospital who doesn't admit peds and 3 PACU RNS from small hospitals who don't do a lot of peds and an Adult ICU RN.


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## PBavaro (Apr 29, 2015)

Handsome Robb said:


> @PBavaro I'm very interested in this. I haven't had a chance to look at it in depth but from what I've seen I really like it.
> 
> Would love to talk to you more about it and what it takes to implement it at an agency as far as the process and any evidence/studies you have supporting its use as well as the discordance from the Broselow tape you noted.
> 
> I actually brought up your method in my PALS recert today but didn't dive too deep into it because I frankly don't know enough and neither of the instructors nor any of my classmates had heard of it. Granted my class had 3 PRN RRTs from a small hospital who doesn't admit peds and 3 PACU RNS from small hospitals who don't do a lot of peds and an Adult ICU RN.



Shoot me over an email Robb with a phone number and I'd love to talk. I have tons of research and support to back up the Handtevy System as well as information for you to share with your PALS class.


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