Broselow Bags/ Pediatric Bags

[HF-EMS]

I am the training officer for an ALS ambulance, we have two ALS fly cars and two ALS ambulances in service at all times. I am an ALS provider. My friend, the equipment coordinator, a BLS provider is re-doing the peds bags, which really just consist of ped NRBs and Cannulas. All the ALS peds supplies are separate in the ALS bag with a broselow tape. I reccomended to him that he should purchase broselow bags, or broselow wheels, that way the ALS peds supplies are integrated into the peds supplies, rather than separate.

What do you guys think?

[Ridryder 911]

Here is a simple suggestion, perform a scenario of an pediatric arrest. Now, use your old system and assemble some pediatric arrest as in Broselow groupings. Then ask for supplies as in a code situation ETT size, IV needle, Ped bi-carb, etc.. , see how fast and proficient it is.

IMHO Broselow is the only safest, and easiest way. Especially if you only periodically have pediatric arrest. one can make their own kit using colored bags or inserts using the Broselow tape as well.

Good luck,

R/r 911

[paramedicmike]

We used to have a set up with all the peds gear stuffed in a bag. It was a pain in the ass trying to find anything...especially when you had a sick kid.

We convinced our boss to buy a couple Broselow bags. Within a month I had worked a padi code using one of our new bags. What a HUGE difference it made in our ability to find not just the equipment we needed but the right sized equipment. Just roll out the bag, match the colors and you're set with all the equipment you'll need. It took less than five seconds to have what we needed at our fingertips (compared to much longer trying to dig it all out of our previous 'stuff everything into here' peds 'bag').

I would definitely recommend getting one for each ALS vehicle you need equipped. Don't be put off by the cost. These things are worth their weight in gold.

Good luck.

-be safe.

[vs-eh?]

In our airway bag, one of the side pouches is used for ped neb masks, SFM, BVM, and smaller OPA's. The intubation roll has all the tube sizes, the drug bag doesn't separtate ped. drug doses or anything. Only recently did we get broselow tapes as well.

I agree with Rid about the scenerio thing. However...

The formula's for ped. arrests are few and easy and in my opinion you should never use a broselow tape as a crutch. If you can't do a ped. arrest with it, there are problems...

Make sure your staff know the ped. arrest algorythym. Make sure they know various ways of calculating tube sizes, weight, etc... In the end they are just educated estimations. As long as you used the proper way of estimation, you'll never be faulted.

[HF-EMS]

its not a question of the algorythms, per se

its a question of Body Mass based dosing of meds. I dont know about you but i never get any information from hysterical mothers.

Broselow doesnt tell you what to use, it makes sure you use the right amt of the drugs

[vs-eh?]

its not a question of the algorythms, per se

its a question of Body Mass based dosing of meds. I dont know about you but i never get any information from hysterical mothers.

Broselow doesnt tell you what to use, it makes sure you use the right amt of the drugs

True, but again that is based (I assume) on ideal body weight for height. Using acceptable methods for weight estimation (AGEx2) + 10 (or 8 depending) are going to offer very comparable results.

Tube size - (AGE/4)+4 or (AGE+16)/4 or (and this comes into play for larger children potentially) diameter of pinky

IV - I think most will simply get whatever catheter is possible

IO - For us anyway we have 2 sizes and it is basically over 1 year old or under (15 or 18 ga)

Suction is basically 1/3 the diameter of the ETT, any small tube (say under 5) will be getting like 6 Fr.

Defib is all 2J/kg>4J/kg>4J/kg

Drugs...

Epi is 0.01mg (0.1ml) 1:10000 IV/IO or 0.1mg (0.1ml) ETT....

Lido is 1.0mg/kg

Dextrose concentration and dosing may very depending on your area. For example we use D25W (made by us) for all under 1 year and D50W >= 1 year.

Fluid is either 10ml/kg or 20ml/kg depedning or your orders/condition/patho of the patient.

These are the most common formulas. Any other intervention will likely be an order and it is up to the doctor. Any ALS provider should commit these to memory.

The tape is good enough, I don't think you would need the bag IMHO.

[HF-EMS]

im not sure where you are from, and it sounds like you guys have a system that works for you, but regional protocols have us go with the nationally accepted broselow system.

To each their own i guess.

And provided I have to use the tape, i might as well have the bag split out for me already, right?

[vs-eh?]

im not sure where you are from, and it sounds like you guys have a system that works for you, but regional protocols have us go with the nationally accepted broselow system.

To each their own i guess.

And provided I have to use the tape, i might as well have the bag split out for me already, right?

Again, I agree that the Broselow tape is a solid method and is all and all great. What I am saying is that it shouldn't be used as a crutch for any and all ped. patients. If drug calculations based on weight are your main concern, the formulas I have given are standards of weight estimation for these patients. All of the formulas are not simply local to me, these are (based) international PALS/NRP guidelines.

I think you just need the tape, and not all the modules and what not. And if that tape should "walk away", you don't want to have your people scratching theirs heads and fumbling with some multicoloured bags because they can't estimate the weight of a 3 year old...

[AZCEP]

If you look closely at the PALS/NRP guidelines they tell you in so many words to have reference material readily available, and to NOT rely on memory for the critical patient.

The Broselow system provides for height specific equipment sizes that have been shown to not change significantly based on body mass or age. Knowing that you have the equipment at hand that you will need makes a tough situation that much easier to work through. The Broselow bag is not intended to carry medications, and they don't recommend IV fluids be regularly stored in them either.

[1EMT-P]

Broselow kits are great, but they can be expensive to purchase... have you thought about purchasing the Broselow tapes and making your own color coded kits?