Guidelines for paediatric emergency equipment and supplies for a physician’s office
Peer review and other recent paediatric literature have suggested that office-based physicians who care for
children should have some basic emergency care equipment, supplies and drugs available to deal with the
occasional life-threatening situation that might occur in the office setting.
The ‘recommended’ equipment, supplies and drugs are considered optimal to support a child until his or her
arrival in the hospital emergency department. The choice of exactly what to obtain depends on the type of
practice and the location of the office. For example, a physician whose office is farther than 30 minutes from a
hospital may stock more of the ‘desirable’ items.
If a basic package of emergency equipment is not available, some medicolegal problems may arise. All
physicians caring for children should be knowledgeable and up-to-date in paediatric cardiopulmonary
resuscitation.
The Canadian Paediatric Society recommends that the materials listed in the tables below be stocked in
physicians’ offices. All drugs should be kept in a locked emergency equipment container, and their expiry dates
reviewed regularly. The total cost of these supplies is less than $1,000.
TABLE 1: Circulation supplies recommended for physicians’ offices
Recommended
Vascular access
Intravenous butterfly needles (25, 23, 21 gauge)
Indwelling intravenous catheters (24 to 18 gauge)
Intravenous fluids and tubing
Normal saline (two 500 mL bags)
Normal saline in 5% dextrose (two 500 mL bags)
Extension tubing
Drip chambers (Solusets)
Syringes (1 cc, 5 cc, 10 cc) with needles
Tape
Tourniquet (rubber bands, tubing)
Sphygmomanometer (with assorted cuffs)
Desirable
T-connectors
Arm boards
Intraosseous needles (16 gauge)
TABLE 2: Emergency drugs recommended for physicians’ offices
Recommended
Epinephrine for anaphylaxis
(1:10,000 solution: 0.1 mL/kg)
(1:1000 solution: 0.01 mL/kg)
Diazepam (0.1 mg/kg every 5 mins, maximum 0.3 mg/kg intravenous or 0.5 mg/kg rectally
[maximum10 mg/dose])
or
Lorazepam (0.1 mg/kg intramuscular or
intravenous)
Dextrose (25%: 1 to 2 mL/kg and
10%: 2.5 to 5 mL/kg)
Salbutamol aerosol, three to six puffs
Dosing cards or tapes
Desirable
Salbutamol solution for nebulization (0.03 mL/kg
maximum 1 mL)
Salbutamol nebules of 2.5 mls:
< 10 kg: 2,5 mg
> 10 kg: 5 mg
Epinephrine (1:1,000): in nebulization for airway compromise
(eg, croup) 0 to 10 kg 2.5 mL, 10 kg 5.0 mL
Or racemic epinephrine: 0 to 10 kg, 0.25 mg; 10 kg, 0.5 mg
Optional
Sodium bicarbonate (full and half-strength)
1 to 2 meq/kg intravenous
Naloxone (0.1 mg/kg to maximum of 2.0 mg
intravenous or intramuscular)
TABLE 3: Trauma and miscellaneous supplies recommended for physicians’ offices
Recommended
Nasogastric tubes (10, 16) French
Emergency equipment container (cart box)
Emergency phone list (police, hospital, etc)
Latex-free gloves
Desirable
Dressings, bandages, splints
Steristrips
Pulse oximeter
TABLE 4: Airway supplies recommended for physicians’ offices
Recommended
Bag-valve-mask (self-inflating with reservoir)
Paediatric volume 100 to 700 mL
Adult volume 700 to 1000 mL
Oxygen masks (adult, child, infant)
Oxygen tank and valve with flowmeter
Oxygen tubing
Spacer device for aerosolized medication (adult, infant)
Desirable
Laryngoscope and blades with endotracheal tubes (various sizes)
or Laryngeal airway masks (various sizes), the choice depending on the level of expertise
Suction machine and catheters
Suction tips (Yankauer)
Compressor with nebulizer and mask
Optional
Nasal cannulae
References
1. Altieri M, Bellet J, Scott H. Preparedness for pediatric emergencies encountered in the practitioner’s
office. Pediatrics 1990;85:710-4.
2. American Academy of Pediatrics, Committee on Drugs. Emergency drug doses for infants and children.
Pediatrics 1988;81:462-5.
3. Birenbaum R. CMA call for emergency kits in doctors’ offices spurs debate. Can Med Assoc J
1991;145:705-6.
4. Fuchs S, Jaffe DM, Christoffel KK. Pediatric emergencies in office practices: prevalence and office
preparedness. Pediatrics 1989;83:931-9.
5. Hodge D. Pediatric emergency office equipment. Pediatr Emerg Care 1988;4:212-4.
6. Holler A, Johnson C, Luten R, et al, eds. APLS: The Pediatric Medical Course, revised edition. Elk Grove
Village: American Academy of Pediatrics, Dallas, Texas, American College of Physicians, 1996.
7. Sapien R, Hodge D. Equipping and preparing the office for emergencies. Pediatr Annu 1990;19:659-67.
8. Seidel J. Preparing for Pediatric Emergencies. Pediatr Rev 1995;16:466-72.
ข้ อมูลจาก Guidelines for paediatric emergency equipment and supplies for a physician’s
office Community Paediatrics Committee, Canadian Paediatric Society (CPS)
Paediatrics & Child Health 1999; 4(3): 217-218
Reference No. CP98-05
(http://www.cps.ca/english/statements/CP/cp98-05.htm)
และยังมีอกี คือ
Resuscitation, Airway Management, and Acute
Arrhythmias: Table 1-3: Drug Doses For Pediatric
Resuscitation
Mark A. Graber, MD
Departments of Family Medicine and Emergency Medicine
University of Iowa College of Medicine
Peer Review Status: Externally Peer Reviewed by Mosby
Table 1-3: Drug Doses For Pediatric Resuscitation
Drug
Dose
Remarks
Adenosine
0.1 to 0.2 mg/kg.
Maximum single does:
12 mg
0.02 mg/kg per dose
Rapid IV bolus.
Atropine sulfate
Bretylium toslyate 5 mg/kg; may be
increase to 10 mg/kg per
dose
Calcium chloride 20 mg/kg per dose
10%
Dopamine
2-20 mg/kg/min
hydrocloride *
Dopamine
2-20 g/kg/min
hydochloride *
Epinephrine for
IV/IO: 0.01 mg/kg
bradycardia
(1:10,000) = 0.1 ml/kg of
1:10,000
ET: 0.1 mg/kg (1:10,000)
= 0.1 ml/kg of 1:10,000
Epinephrine for
First dose: IV/IO: 0.01
asystolic or
mg/kg (1:10,000) = 0.1
pulseles arrest
ml/kg of 1:10,000.
ET: 0.1 mg/kg (1:1,000)
= 0.1 ml/kg of 1:1,000.
Doses as high as 0.2
Minimum dose: 0.1 mg. Maximum single dose: 0.5
mg in child, 1.0 mg in adolescent.
Rabid IV.
Give slowly.
Titrate to desired effect.
Adrenergic action dominates at > 15-20 g/kg/min.
Be aware of effective dose of preservatives
administered (if preservatives are present in
epinephrine preparation) when high doses are
used.
Be aware of effective dose of preservative
administered (if preservatives prsent in epinephrine
preparation) when high doses are used.
mg/kg may be effective.
Subsequent doses:
IV/IO/ET: 0.1 mg/kg
(1:1000) = 0.1 ml/kg of
1:1000.
Doses as high as 0.2
mg/kg may be effective
Epinephrine
Initial at 0.1 g/kg/min. Titrate to desired effect (0.1-1.0 g/kg/min).
infusion
Higher infusion dose
used if asystole present.
Lidocaine
1 mg/kg per dose
Lidocaine infusion 20-50 g/kg/min
Sodium
1mEq/kg per dose or 0.3 Infuse slowly and only if ventilation is adequaqte.
bicarbonate
x kg x base deficit
From JAMA 268:16, 2000.
IV, Intravenous, IO, intraosseous, ET, endotracheal.
* Run these drugs in rapidly at first to clear the line and ensure drug delivery. When note clinical
response (increase in heart rate, blood pressure), decrease drip rate to desired infusion rate.
Defibrilation: Energy dose = 2 J/kg. If this not effective, use 4 /kg = 2.<BR>
Dilutions: For dopamine and dobutamine: 6 x body weight (kg) = # of mg in 100 ml D5W then 1
ml/hr = 1.0 g/kg/min.
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