Handtevy for Peds.

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.
 
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 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.
 
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.
Click to expand...

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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