Some basics on Peds ED stuff

CodeteamB · May 20, 2013

Allo,
So I'm working in an adult only ED, and feel like I'm missing out on some very important basic Peds for ER type stuff.
Can anyone give me a bunch of hints/tips?
Like what are some serious emergencies and how do you manage them?
Meds and doses for seizures and the like....
how the heck you get a tiny IV in that tiny vein.
thanks!

1- serious emergencies

There is a wide variety of emergencies, what I see most often is respiratory issues (croup, asthma), sepsis and trauma. We manage them very similarly to adult emergencies with the exception that we stabilize and transfer to the local kids hospital when the case warrants (this is where the peds ICU is located).

2- meds and dosages

The broselow tape is the best friend of the critical care pediatric nurse. It has weight based dosages for ACLS and second line meds as well as volumes for bolus and maintenance fluids, equipment sizes etc.

3- tiny IVs and veins

Very similar to putting a large IV in a large vein... Make sure you have lots of help to hold/soothe the child, use an appropriately sized catheter, remove the tourniquet as soon as possible and flush slowly. Wrap that arm up securely and use an arm board.

I highly recommend taking ENPC for complete answers to these questions as well as very important info on how to assess pediatric patients.

As an adult only site do you still get children at times? Just my own curiosity about your curiosity

germsjackson · May 20, 2013

its curious that you're curious about my curiousity....

we have a separate peds ed, but they are moving to a different site in the hospital, and as this transition happens, we need to be more prepared for displaced families and EMS........

CodeteamB · May 20, 2013

Ah, I see. You should definitely take ENPC. It is a really good course. It increased my confidence with pediatrics in an amazing way. I still hate getting kids but my peds panic is gone.

turnforthenurse, MSN, NP · May 21, 2013

Do you need to be working in the ER for a certain amount of time before taking ENPC? I couldn't find any information regarding this.

CodeteamB · May 21, 2013

Do you need to be working in the ER for a certain amount of time before taking ENPC? I couldn't find any information regarding this.

No. We had floor nurses in the class I took.

Esme12, ASN, BSN, RN · May 21, 2013

There are no real quick tips. It's curious that you would be curious working in an adult ED...but I see the dilemma. Invest in a pedi code cart. Luckily kids don't code often. The goal with children is to intervene before they are at the coding stage. I highly recommend ENPC along with PALS. Check out this thread https://allnurses.com/emergency-nursing/adult-er-nurse-742288.html

Remember their normal vitals are not adult vitals, small mistakes in dosages carry huge consequences. I posted this once before....

Wow......get the ENPC course book and read it. pediatrics is a specialty all it's own. their airways are different....smaller and structurally....they can eat and breathe. remember that 1mm of swelling on an adult airway that is 5mm wide is completely than 1mm of swelling on a 1mm airway. vital signs are not a predictor of how sick a kid is for they can compensate forever and by the time they reflect it in their vitals....they are in critical trouble. the cap refill/urine output is a great indicator on the younger pedi population as an indicator of distress and end organ perfusion.
so when did they last pee and how many wet diapers in x amy of time is huge!!!! using accessory muscle is a huge sign of distress.
they need fluid, o2, and keep them warm. a crying and screaming kid is a stable kid....it's the quiet ones that will/should scare you. if the child has a congenital/chronic illness listen to the parent.....they have done this before and can help you.
rhythms for kids....slow, fast, and absent. familiarize yourself with the normal vital signs for the age group!

infants....was the baby full term, what was birth weight, weigh all babies regardless of what the parents say...emphasize how important it is as that is how the medicines are given. small mistakes have huge consequences for the pedi population. if they are small so should the dose be as all doses are weight based.
the enpc (emergency nursing peds course) has a terrific pets triage standard that should be used by all eds.
ciiamppedds: c is chief complaint, i is immunizations, i is isolation (has the child been exposed to any communicable diseases), a is allergies, m is medications,p is past medical history, p is parents impression of the child's condition, e is the event surrounding the illness or injury, d is diet, d is diapers (voids) and s is signs and symptoms
great power point triage assessment
http://webmedia.unmc.edu/bioprepare/...c%20triage.pdf
[TABLE=class: cms_table]
[TR]
[TD=align: left]age group[/TD]
[TD=width: 23%, bgcolor: #ffffff, align: left]respirations[/TD]
[TD=width: 24%, bgcolor: #ffffff, align: left]heart rate[/TD]
[TD=width: 26%, bgcolor: #ffffff, align: left]systolic blood pressure[/TD]
[/TR]
[TR]
[TD=width: 27%, bgcolor: #ffffff, align: left]newborn[/TD]
[TD=width: 23%, bgcolor: #ffffff, align: left]30-50[/TD]
[TD=width: 24%, bgcolor: #ffffff, align: left]120-160[/TD]
[TD=width: 26%, bgcolor: #ffffff, align: left]50-70[/TD]
[/TR]
[TR]
[TD=width: 27%, bgcolor: #ffffff, align: left]infant (1-12 mo)[/TD]
[TD=width: 23%, bgcolor: #ffffff, align: left]20-30[/TD]
[TD=width: 24%, bgcolor: #ffffff, align: left]80-140[/TD]
[TD=width: 26%, bgcolor: #ffffff, align: left]70-100[/TD]
[/TR]
[TR]
[TD=width: 27%, bgcolor: #ffffff, align: left]toddler (1-3 y)[/TD]
[TD=width: 23%, bgcolor: #ffffff, align: left]20-30[/TD]
[TD=width: 24%, bgcolor: #ffffff, align: left]80-130[/TD]
[TD=width: 26%, bgcolor: #ffffff, align: left]80-110[/TD]
[/TR]
[TR]
[TD=width: 27%, bgcolor: #ffffff, align: left]preschooler (3-5 y)[/TD]
[TD=width: 23%, bgcolor: #ffffff, align: left]20-30[/TD]
[TD=width: 24%, bgcolor: #ffffff, align: left]80-120[/TD]
[TD=width: 26%, bgcolor: #ffffff, align: left]80-110[/TD]
[/TR]
[TR]
[TD=width: 27%, bgcolor: #ffffff, align: left]school age (6-12y)[/TD]
[TD=width: 23%, bgcolor: #ffffff, align: left]18-25[/TD]
[TD=width: 24%, bgcolor: #ffffff, align: left]70-110[/TD]
[TD=width: 26%, bgcolor: #ffffff, align: left]85-120[/TD]
[/TR]
[TR]
[TD=width: 27%, bgcolor: #ffffff, align: left]adolescent (13y +)[/TD]
[TD=width: 23%, bgcolor: #ffffff, align: left]12-20[/TD]
[TD=width: 24%, bgcolor: #ffffff, align: left]55-110[/TD]
[TD=width: 26%, bgcolor: #ffffff, align: left]100-120[/TD]
[/TR]
[TR]
[TD=width: 27%, bgcolor: #ffffff, align: left]adult[/TD]
[TD=width: 23%, bgcolor: #ffffff, align: left]16-20[/TD]
[TD=width: 24%, bgcolor: #ffffff, align: left] 70-100[/TD]
[TD=width: 26%, bgcolor: #ffffff, align: left]
[/TR]
[/TABLE]

triage course - nursing continuing education (ce) - nurse ce - ceufast.com

pews.....the pediatric early warning (pew) score system can help nurses assess pediatric patients objectively using vital signs in the pediatric intensive care unit. the scoring system takes into account the child's behavior, as well as cardiovascular and respiratory symptoms. http://www.colorado5millionlives.org...t-8.08-pg9.pdf

ahrq innovations exchange | pediatric early warning (pew) score system

this is another great assessment tool for assessment short and sweet but informative.

http://www.ucdenver.edu/academics/co...m_pews_tch.pdf

Guest219794 · May 22, 2013

Here is a tip-

Diastat is made deliberately difficult to adjust the dose, so that a parent can't change it once it has been set.

Make sure you know how to adjust the dose before you have a seizing baby and a frantic parent.