Guidelines for paediatric emergency equipment and supplies for a physician's office

Question 1

What are the most common pre-arrest conditions affecting children as an outpatient?

Answer 1

1. Respiratory emergencies

2. Trauma

Question 2

What principles should be considered when determining which equipment, supplies and medications are considered optimal in the outpatient setting?

Answer 2

1. The nature of the emergencies most likely to be encountered
2. The nature of the intervention and how difficult it is to acquire and maintain the skills necessary to operate the equipment
3. The value of the intervention
4. Availability of EMS

Question 3

What are the recommendations re: office providers and emergency management?

Answer 3

1. All physicians caring for children should be knowledgeable and up to date in basic paediatric cardiopulmonary resuscitation. Physicians who are remove from EMS should be up to date in paediatric advanced life support.
2. Office-based providers of health care for children should conduct periodic mock codes.
3. A written protocol for emergencies should be posted in an easily accessible place, and should include preprinted drug dosages and an emergency telephone list (police, hospital, etc).

Question 4

What circulation supplies are recommended for physician’s offices?

Answer 4

1. Cardiac arrest backboard
2. Sphygmomanometer (with assorted cuffs)
3. Intraosseous needles (16 gauge)
4. Intravenous fluids and tubing
5. Normal saline (two 500 mL bags)

Question 5

What circulation supplies are desirable for physician’s offices?

Answer 5

1. Vascular access
2. Intravenous butterfly needles (25, 23, 21 gauge)
3. Indwelling intravenous catheters (24 to 18 gauge)
4. Normal saline in 5% dextrose (two 500 mL bags)
5. Extension tubing
6. Drip chambers (solusets)
7. Syringes (1 mL, 5 mL, 10 mL) with needles
8. Tape
9. Tourniquet (rubber bands, tubing)
10. T-connectors
11. Arm boards

Question 6

What emergency drugs are recommended for physician’s offices?

Answer 6

1. Dosing cards or tapes
2. Epinephrine for anaphylaxis (1:1000 solution: 0.01 mg=mL/kg to a maximum of 0.3 mg/dose)
   Intramuscular route in the vastus lateralis muscle
3. Salbutamol solution for nebulization: 0.5 mL (of 5 mg/mL solution = 2.5 mg) diluted to 3 mL in saline for infants and toddlers
   and 1 mL diluted to 3 mL in saline for older children
4. Epinephrine (1:1000) for nebulization for airway compromise (eg, croup) 0.5 mL/kg (max 5 mL)
5. Compressor with nebulizer and masks of various sizes

Question 7

What emergency drugs are desirable for physicians’ offices?

Answer 7

1. Epinephrine (1:10,000) Should be given if intraosseous access is available for paediatric advanced life support. Should not be stocked by non-paediatric advanced life support certified providers if this leads to confusion with 1:1000 concentration

2. Diazepam (0.1 mg/kg every 5 min, maximum of three doses or 0.3 mg/kg intravenous or 0.5 mg/kg rectally)
or lorazepam (0.1 mg/kg intramuscular or intravenous)

3. Chemstrips and lancets for blood glucose determination
4. Dextrose (25%: 1 mL/kg to 2 mL/kg and 10%: 2.5 mL/kg to 5 mL/kg)
5. Dextrose gel
6. Salbutamol aerosol: three to six puffs

Question 8

What trauma and miscellaneous supplies are recommended for physicians’ offices?

Answer 8

1. Stiff neck collars (large and small)
2. Dressings, bandages, splints
3. Emergency equipment container (cart box)
4. Latex-free gloves

Question 9

What trauma and miscellaneous supplies are desirable for physicians’ offices?

Answer 9

1. Nasogastric tubes (10, 16 F)

2. Steristrips, dressings, bandages, splints

Question 10

What airway supplies are recommended for physicians’ offices?

Answer 10

1. Bag valve mask (self-inflating with reservoir)
   Paediatric volume: 100 mL to 700 mL
   Adult volume: 700 mL to 1000 mL
2. Oxygen masks (adults, children and infants)
3. Oxygen tank and valve with flow meter
4. Oxygen tubing

Question 11

What airway supplies are desirable for physicians’ offices?

Answer 11

1. Pulse oximeter
2. Laryngoscope and blades with endotracheal tubes (various sizes) or laryngeal airway masks (various sizes), the choice depending on the level of expertise
3. Suction machine and catheters
4. Oral airways, various sizes
5. Suction tips (Yankauer)
6. Spacer device for aerosolized medication (adult, infant)