However, when incorrect, the actual weight differed from the predicted weight by two or three color intervals. On the other hand, the tape correctly predicted weight in two-thirds of the children under 75 cm in length. When incorrect, the actual weight differed from the predicted weight in the taller children by only one color interval. The tape was least accurate in taller children, correctly predicting weight in about 46% of the children over 75 cm in length (29.5 inches). When the tape was incorrect, three-quarters of the patients (77.1%) were heavier than what the tape predicted, which would have resulted in medication under dosing, insufficient fluid replacement volumes, lowered defibrillation energy levels, and undersized equipment. Of the 657 patients included in the study, the Broselow™ Tape accurately predicted the child’s weight less than half of the time (46.9%). Researchers plotted the actual length measurements against the Broselow™ Tape to get an expected weight for each child and then compared the predicted weight against the actual weight. Of these, only 657 (27.9%) of the children had both length measurements covered by the Broselow™ Tape and actual weight measurements recorded by the hospital staff. Using the medical records at a level-one trauma center, researchers identified 2359 pediatric patients treated for a trauma-related complaint during a five-year period beginning in 2002. For obvious reasons, healthcare providers cannot use the tape when children who are too short or too tall to fit within the measurement boundaries of the tape. All children whose length places them within a single color zone receive the same dose. The tape is divided into nine color zones with precalculated drug doses, fluid volumes, and equipment sizes for each zone. The Broselow™ Tape is calibrated for pediatric patients between 46 cm and 146.5 cm in length, which correspond to a weight range of 3 kg to 34 kg. Researchers in West Virginia sought to determine the accuracy of the Broselow™ Pediatric Emergency Tape in estimating pediatric weight (Knight et al., 2011). Medic Ortiz says that he delivered the correct drug dose recommendation from the weight-based measuring tape, but wondered if the doses were too small given the fact that the child was overweight. The hospital staff continues the resuscitation effort for about an hour however, the patient does not respond.īack at the station, the medics and the firefighters talk about the call and why nothing seemed to work. On arrival in the emergency department (ED), the patient’s ECG displays asystole. On the way to the hospital, the boy receives three additional doses of epinephrine, two additional doses of amiodarone, and two additional countershocks. At the two-minute mark, the boy receives a third countershock at 100 joules, the firefighters resume CPR, and the resuscitation team prepares for transport. Medic Ortiz delivers a 125 mg dose of amiodarone (5 mg/kg).
Ventilation with a bag-valve mask is adequate and the medics agree that endotracheal intubation is not warranted. Medic Stevens delivers a second countershock of 100 Joules (4 J/kg) and the firefighters resume CPR. Medic Ortiz quickly establishes intraosseous access in the boy’s left tibia and administers 2.5 ml of epinephrine 1:10,000 (0.01 mg/kg).Īfter two minutes of high quality CPR, the boy remains in VF. Medic Stevens delivers a single countershock at 50 Joules (2 J/kg) and the firefighters resume CPR. Using a weight-based measuring tape, Medic Ortiz estimates the child’s height to be between 122 cm and 133.5 cm, which corresponds to a weight range of 24 kg to 29 kg. The boy’s electrocardiogram (ECG) reveals ventricular fibrillation. Medic Stevens cannot detect a pulse and instructs two of the firefighters to begin cardiopulmonary resuscitation (CPR). The child is motionless with agonal respirations. Someone from the office contacted the boy’s mother, who is now on her way to the school. One of the teachers says the kids were playing basketball when the boy suddenly collapsed and began convulsing. When they arrive, they find a seven-year-old male lying in the gymnasium floor surrounded by other children and two adult teachers. Medic 44 and Engine 18 respond to an elementary school on a report of a child having a seizure.
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