Does that protocol cover times of low staffing? EMS personnel can provide competent assistance to the office team. 10 GUIDELINES FOR THE MANAGEMENT OF PAEDIATRIC EMERGENCIES Example: A 20 kg, 6 year old boy who is 10% dehydrated, and who has already had 20ml/kg saline, will require: Deficit - 10 % x 20 kg = 2000 ml Plus maintenance each 24 hours - 60ml x 20kg = 1200 ml Maintenance for 48 hr - 1200ml x 2 = 2400 ml Total = 4400 ml What is your office setting (freestanding office, clinic based, health center based, hospital based, other)? Appendicitis– inflammation of the appendix, Asthma-related problems – problems caused by asthma, a disorder of the breathing airway that can cause wheezing and shortness of breath, Broken/fractured bones– breaks or fractures in bones, Constipation– bowel movements that are difficult to pass and/or infrequent, Croup– a condition with a loud, distinctive cough that leads to difficulty in breathing, Dentistry problems– any issues related to teeth, including missing or broken teeth or trauma to the mouth, Dehydration– a condition caused when the body does not have enough water, Diabetes-related problems – any problems caused when there is too much sugar in the blood, which may result in vomiting and dehydration, Diarrhea– too much water in bowel movements or stool, Head injuries – trauma to the head, such as a concussion, Poisoning– swallowing or inhaling a toxic substance that may cause pain or breathing problems, Rash– an inflammation that causes changes to the skin’s color or texture, such as a diaper rash, sunburn or ringworm, Seizures– abnormal electrical activity in the brain that may result in loss of awareness and changes in physical movement, as well as thrashing, Sprains, strains and tears – injuries to the body’s ligaments or muscles, Vomiting– throwing up the stomach’s contents, © 2019 Brenner | Site Policies & Statements. What are the high and low staffing points during the times when your office is open? Disaster preparedness is built on and dependent upon pediatric emergency systems of care that operate effectively day-to-da Indeed, studies have shown that a substantial number of practices are not prepared to manage pediatric emergencies and have documented deficiencies in equipment and training.3,4 One study showed that physicians with training in advanced pediatric life support (APLS) were more likely to have resuscitation equipment and to have conducted a mock code in their office.4 Other studies have supported training in basic life support (BLS) as well as advanced life support (ALS), as suggested by the American Academy of Pediatrics (AAP) policy statement published in December 2004.5 The statement suggested that pediatricians will improve the chance of survival of children who experience cardiac arrest by advocating for cardiopulmonary resuscitation (CPR) training of parents and caregivers and participating in BLS training courses as participants and instructors. In the evaluation of upper airway abnormalities, the current standard for imaging relies initially on radiography, which may then be followed by contrast-enhanced computed tomography (CECT) of the neck. Despite these findings, which suggest that a significant number of children present to primary care offices with urgent or emergent problems, some health care professionals discount the need for preparation because “emergencies are not very common” or because they feel they can rely on rapid response from emergency medical services (EMS) or proximity to a hospital. Pediatric emergencies do require a particular skill set that may be different from adult emergencies. Office Preparedness for Pediatric Emergencies. Invite local EMS to participate in regularly scheduled office mock codes. Do you have need for any additional equipment or expertise should a technology-dependent child have an emergency in your office? Aust Fam Physician. Educate families about what to do in an emergency. The office site then serves as an entry into the emergency care system, and it is there that vital, perhaps even life-saving, care is provided. Do you have need for any additional equipment or expertise if a technology-dependent child should have an emergency in your office? How far is your office from a site of definitive care, such as the nearest ED, or the nearest pediatric center? Article: KB00027. Is your waiting room under direct observation or screened frequently by a clinical staff member? With the family's consent, mechanisms to identify children with special needs in an emergency can be established and shared with local EMS providers.15. Learn about each threat and what steps to take to deal with it. Emergency situations are the most difficult to document properly. Biological EmergenciesThese include diseases as well as biological agents that may be used for terrorism. What is the emergency readiness training of the staff present during those times? In the long run, it is much better to have a unit respond even if the call is canceled en route or the child is not transported if he or she stabilizes in the office. Tickets go on sale at 6pm BST on 31st August 2019. As an example, more than 2400 life-threatening pediatric emergencies per year were reported in a telephone survey of 51 pediatric offices in one suburban county of Connecticut (an average of 24 emergencies per office per year) . Successful stabilization requires an effective team, and members of the office staff need to be prepared; they need adequate knowledge, training, and resources to respond to an emergency.10 They also need an opportunity to practice; awareness of each member's role on the team and an opportunity to rehearse these roles will lead to a more highly functioning, effective emergency team. Parent education regarding prevention, recognition, and response to emergencies, patient triage, early recognition and stabilization of pediatric emergencies in the office, and timely transfer to an appropriate facility for definitive care are important responsibilities of every pediatric primary care provider. Skilled physicians who work with appropriate equipment and a well-trained team, in collaboration with the EMS system, can achieve timely resuscitation and transfer to definitive care and offer the best chance for intact survival for every child and family who seeks their care in an emergency. Are there resources outside your office on which you could call during an office emergency (eg, security, other medical or dental professionals in the same building, hospital code team)? Seizures: 1-year-old with a complex febrile seizure; pulling at her ears and found to have a temperature of 104°F; mom gave her a bath to cool her off, and she began to have a generalized seizure several minutes later; her parents rushed her to the office while carrying her on their laps; the seizure has persisted for over 20 minutes. In another study, 62% of pediatricians and family physicians in an urban setting who were asked about emergencies in their offices reported that they assessed more than 1 patient each week in their offices who required hospitalization or urgent stabilization.2. Personnel who fulfill this role should receive training specific to accessing EMS, and they should be knowledgeable about the capabilities and level of response provided by the local EMS agency. PALS (Pediatric Advanced Life Support) and APLS (Advanced Pediatric Life Support) courses provide an excellent opportunity to renew knowledge and skills. What is the point of entry for your local 9-1-1 response team (ie, the facility to which they are required by field protocol to bring a pediatric patient)? The 26 kg is used to figure drug dosages. Sepsis: 2-year-old with meningococcemia; well in past but found this morning with rash, moaning and minimally responsive; had upper respiratory infection yesterday and 2 episodes of vomiting; otherwise fine. Our health care professionals provide exceptional care and services using the latest in technology and medical advancements with diagnostic and treatment tools designed specifically for use in children. Although maintaining knowledge and skills of clinicians is important, more is involved to ensure that the best care is provided to every child who is brought to the office with an emergency. In this module we will focus on the “not just little adults” population of patients that present to the emergency department. PPCPs can facilitate training in BLS and ALS by providing time for employees to take training courses offered in the community or local hospital or by collaborating with local EMS personnel who can offer training courses on site at the office. Resuscitation equipment can be kept in an examination room designated as the resuscitation room, which is prestocked in an organized way, or it can be stocked and organized in a box, to be taken to the site of the resuscitation. We also discuss lower-airway emergencies, including pediatric chest trauma and common causes of cough and wheezing. It may be helpful for PPCPs to assess the skill level and knowledge of new employees and clinical care providers who will likely have different levels of experience in handling pediatric emergencies. Clinical staff can then be asked to locate specific pieces of equipment they may need for the resuscitation. Trained personnel must have rapid access to appropriate equipment and medications to use at the time of an emergency. We access the first Level I Pediatric Trauma Center in North Carolina and are the only pediatric emergency department in the region. The skills required to perform these tasks successfully are usually acquired in training, but many PPCPs do not use them frequently, because the incidence of office emergencies is not high. 1. Pediatric advanced life support (PALS)28 and APLS29 courses provide an excellent opportunity to renew knowledge and skills. Careful self-assessment of office practice and policies can optimize office readiness before an emergency. Some PPCPs have interpreted risk-management guidelines to mean that having emergency equipment and medications on site will increase their liability in emergency situations; however, lack of preparation may be a true cause of increased liability. (Include nights and weekends if applicable.) HR indicates heart rate; RR, respiration rate; BP, blood pressure; Pox, pulse oximetry; IO, intraosseous needle; IV, intravenous catheter. PPCPs should discuss advance directives and limitation of life-sustaining treatment with a family before any emergency develops.14 Because some states do not allow EMS personnel to recognize and respect pediatric advance directives, it is critical that any out-of-hospital do-not-resuscitate or “accept-natural-death” orders be discussed at the time of their issue with local EMS medical directors to ensure that EMS personnel, when called and asked to perform comfort measures instead of aggressive resuscitative measures, are acting within preapproved medical direction and remain free from liability. Common Pediatric Emergencies. Cardiac arrest (see Chapter 11) Vasovagal syncope (simple faint) The ‘simple faint’ is the most common medical emergency to be seen in dental practice and results in loss of consciousness due to inadequate cerebral perfusion. Emergency rooms treat patients with life-threatening conditions who need care immediately, such as when there is: Serious risk to the health of the individual, or … Do you have specific telephone triage protocols for nonclinical and clinical staff? You will be redirected to aap.org to login or to create your account. Examples of dental emergencies. For example, PPCPs can collaborate with local EMS to offer life-support training courses; provide office-based pediatric training for EMTs; participate in development of pediatric protocols with EMS; serve as advisors for out-of-hospital pediatric care review; and advocate for EMS to obtain appropriate pediatric training, equipment, and supplies. Pitt R. A medical emergency can be defined as an acute change in physiological or psychological status likely to result in death, disability, or delayed recovery without prompt and appropriate treatment. Pediatric care protocols adapted from EMS providers might help provide a basis for the development of individualized office-based protocols and scenarios for the top 5 to 10 emergency conditions. When a child requires resuscitation in an office, the PPCP and office staff members need help from other members of the emergency care team to ensure the best possible outcome. In many communities, paramedics have assisted pediatricians by helping to teach PALS or CPR classes to office staff. Documentation should also be included in office training and mock codes and, most importantly, during true resuscitation attempts. They can be taught about signs and symptoms that may signal an emergency in a child, such as labored breathing, cyanosis, audible stridor or wheezing, grunting or flaring, seizures, depressed mental status, or uncontrolled bleeding.16 Front-desk personnel or the office nurse might periodically check the waiting area, especially if the waiting time for an acute care visit is prolonged or the waiting area is not under direct visual supervision. The PPCP can “run the code” and provide medical direction, but a contingency plan should be developed to guide staff if no physician is in the office at the time of the emergency. Consult your local EMS to review office emergency procedures, access, and equipment in light of their response time, medications, equipment, and destination options. Offer your office as a pediatric training and refresher site for EMTs. Facilitate use and maintenance of emergency information forms for children with special health care needs. Recommended Equipment for Pediatric Office Emergencies, Health care professionals, patients, and families have developed an increased awareness of issues related to patient safety since the release of the Institute of Medicine report on medical errors in 1999.18 Current safety literature suggests that pediatric patients are especially susceptible to medication error (dosing error) because of the need to calculate doses rather than using standardized dosing as in adult medicine.19,20 Over the past few years, a number of clinical tools have been developed to help decrease medication errors. The Emergency Nurse Pediatric Course, developed by the Emergency Nurses Association, provides training in basic assessment, triage skills, critical care, and pediatric emergent situations. Include documentation as a defined role for a staff member. Inquiring about the existence of a local Emergency Medical Services for Children–sponsored “child alert” program can further enhance the EMS response and care by strengthening the link with responding EMS personnel and decreasing the anxiety levels of parents, EMS personnel, and hospital staff. Emergency Medical Services for Children: The Role of the Primary Care Provider. Asthma: 8-year-old with asthma; has been wheezing for 2 days with upper respiratory infection but worsened this afternoon; told mom before he was brought to the office that he had been giving himself puffs of his inhaler every half hour most of the day. The office staff with out-of-hospital and hospital-based emergency providers to ensure optimal emergency care team stay safe is... ; polyuria and polydipsia for 1 week ; today lethargic and confused glucose. For high-quality emergency care system separate them with commas telephone triage protocols for common office,! 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