PALS meds

[ERERER]

trying to set up our cart to make it easier during pediatric codes:

1. do you further dilute meds like epi, atropine, before giving? or do you use a 1cc syringe for those little doses???

2. do you use the "rule of 6" on the Braselow tape to mix drips, or do you use your facility's premixed drips (dopamine, epi, etc).

3. any tips to make things run more smoothely?

[shadowflightnurse]

i have seen it done multiple ways. usually no need to dilute the meds, unless there is no ivf's flowing. if fluids are running slow, follow with flush. as far as the rule of 6's, i have usually seen the pre-mixed meds initially. but after the pt is stabalized, the picu will usually re-mix...so it can be more fine tuned. if your dept rarely see a peds code, they are usually a cluster. even in some peds ed's, i've seen the staff worked up beyond being beneficial to the pt. the best suggestion to get things running is practice, practice, practice. getting a pals re-cert every couple of years, but not actually doing any peds codes is (imho) almost a waste of time. realistic scenarios with actual rhythm strips, drug dosages and discussions are very helpful. if you are going to make charts (ie for drips, code meds, etc) i would suggest a page for each weight with the appropriate dose (mg AND cc's) in a table instead of one page for epi, one page for atropine, etc. i like everything i need for a 5 (or 10 or 20, etc) kg pt in one easy place.

good luck

try this website for an idea on the charts

http://www.cincinnatichildrens.org/ed/cme/ems/formularies.htm

[ERERER]

thanks so much for your info...... the link to cheat sheets was just what we need. printed them up at work, but like everything ... have to get admin approval to put it out. you are right about cluster*! i am fairly comfortable with peds/codes. but those who avoid kids like the plague are sometimes the only ones on duty. not to mention the docs, who just throw you the Braselow tape and say go for it. lots of controversy right now with JACHO and the rule of 6, from what i see there has been no decision made. thanks again for your response, it really helps and may even save a wee one

[shadowflightnurse]

no problem. good luck with getting anyone to accept the change :chuckle

i'm not sure about the JCAHO issue, haven't heard anything.

[KatieBell]

Our ED did a thing regionally-. Our peds resource showed up (with agreement of the manager) to different ED's in our region, a 2 yr old rescue Annie and a scenario.

The ED nurses had to resus the rescue Annie.

I made photographs to provide feedback.

It was like a fire drill. Some departments did great, others, measured the patient putting the head where the feet should be on the braslow tape...etc.

I seem to remember the same peds resource setting up bags that corresponded with the color on the braslow tape with charts, and syringes with stopcocks attached. (Sorry don't work there anymore).

[janejoeben]

Hi, don't know if this is any use but in my dept. in the UK we have a braslow matress rather than a tape, (makes it much less likely to get the head end wrong!) We also have a trolly in the room with colour coded draws with all the sized stuff for that weight, et tubes, cathaters, airways etc.. along with a list of the drug doses for the weight. This makes everything in the right place, you just measure the child on the matress on the trolly, open the corresponding colour coded drawer and everything is there. Works well for us!:)