1. 10 Tips For Preparing For Pediatric Office Emergencies

2. #1. The Office Self Assessment What type of emergencies do you see? How often? Location, setting, resources? Staffing, training? Equipment, supplies, meds on hand? http://pediatrics.aappublications.org/cgi/reprint/120/1/200

3. #2. Essential equipment and supplies Equipment Oxygen-delivery system Bag-valve mask Suction Nebulizer Oropharyngeal airways Pulse oximeter Supplies Cardiac arrest board Sphygmomanometer with cuffs Splints, sterile dressings Strongly Suggested Vascular access and fluid management supplies

4. #3. Keep a card, chart or tape handy Color-coded tape or preprinted drug doses Recognition works better than memory

5. #4. Essential Medications Essential 1.Oxygen 2.Albuterol for inhalation 3.Epi 1:1000 Strongly recommended *Activated charcoal *Antibiotics Anticonvulsants - benzos Atropine Corticosteroids D5 0.45 NS *Dextrose 25% Diphenhydramine Epi 1:10,000 Naloxone *Normal saline or Lactated Ringer’s Sodium bicarbonate 4.2%

6. #5. Maintain your resuscitation skills In the setting of a pediatric emergency, primary care pediatric providers must be able to provide basic airway management and initiate treatment of shock PALS and APLS are two excellent courses to develop and renew knowledge and skills

7. #6. Train your staff with CPR Anytime ®

8. CPR Anytime ® for children and adults

9. #7. Recognize emergencies early Every person in the office should be trained to recognize a potential emergency Extremely labored breathing Blue or pale color Noisy breathing Altered mental status Seizure Agitation (in the parent) Vomiting after a head injury Uncontrolled bleeding

10. #8. Have a plan to call for help Have a plan for arranging transport –How –Where The person arranging transport is responsible for the safety of the patient Call ahead and talk to a doctor

11. #9. Translate research into practice Always use two person bag mask resuscitation Davidovic et al. Annals Emerg Med. 2005;46:37-42 Early recognition, resuscitation and reversal of septic shock in children makes a difference – it improves outcome Han YY, Carcillo JA, Dragotta M et al. Pediatrics. 2003;112;793-799 Therapy for shock should be initiated from the time of diagnosis not transport

12. #10. Teach your patients about emergencies Encourage first aid training and CPR training for parents and caregivers Provide access numbers for after-hours advice, emergency response system and poison control Teach your families about the symptoms and situations where they should seek immediate help

13. Summary Perform an office self-assessment Have essential equipment, supplies and meds on hand Refresh and renew your skills Use two person bag mask technique Treat shock early, it improves outcome For questions or comments e-mail me at jknapp@cmh.edu jknapp@cmh.edu