You Make the Call – Dose That Kid!

Welcome back to every Paramedic’s worst nightmare-

DOSE THAT KID!

The wildly entertaining game show that makes you actually learn what kids weigh by looking at them without being given their specs on a written exam.

So there can be no cheating, despite your best efforts to find someone who knows the age/history of the child, none can be found.  Your Braslow tape was left on the bed in the ER last night.  Also, for you out there in the know, all of the clothing tags have been removed, so no excuses.  Now let’s play DOSE THAT KID!

elizaOur first contestant has been found in a child care center in a woman’s garage.  They state the girl is new to the group and they have no information on her whatsoever.  She was having a bottle when she choked,turned blue and is now unconscious, unresponsive and in vfib.  Your partner is managing the airway and has IV access. DOSE THAT KID!

Agree? Disagree? Have something to add? Why not leave a comment or subscribe to the RSS feed to have future articles delivered to your feed reader?

34 thoughts on “You Make the Call – Dose That Kid!”

  1. I'll regret this because I'm bad at guessing anyone's weight from a picture but I'm feeling saucy this morning. Kid looks about 15lbs so thats 6.82kg round it up to 7kg to make things easier. So here in the backward Chicago EMS systerm we would have- defib@ 14J initially (2J/kg) then defib@ 28J (4J/kg) Epi 1:10,000 @ 0.07mg Lido @ 7mg followed by repeat doses 3.5mg up to a max of 100mg. Now tell me that the kid actually weighs somehting like 30lbs so i can feel bad about myself.

  2. I’ll regret this because I’m bad at guessing anyone’s weight from a picture but I’m feeling saucy this morning. Kid looks about 15lbs so thats 6.82kg round it up to 7kg to make things easier. So here in the backward Chicago EMS systerm we would have- defib@ 14J initially (2J/kg) then defib@ 28J (4J/kg) Epi 1:10,000 @ 0.07mg Lido @ 7mg followed by repeat doses 3.5mg up to a max of 100mg. Now tell me that the kid actually weighs somehting like 30lbs so i can feel bad about myself.

    1. Angelo,
      Thanks for reading and even more for weighing (hahaha..cough…no? weighing? I thought it was funny) in on this new topic.
      Those of us with kids have an advantage in these scenarios not unlike someone with a family member with Down’s Syndrome can assess that population better. As more folks chime in and we see a variety of responses, let’s focus on how slightly the doses will vary and remember that all our math boils down to us guessing their weight to begin with.

  3. That’s about an 8 lb rug rat (I have some so I can call them that)=4kg est.
    We’ll start with shock at 8 j and go right into CPR
    IV’s up so 1:10,000 Epi .04 mg, reevaluate for 4J/kg if needed defib.
    And so on…………
    But I noticed that you said she was in a garage at a daycare. Was the patient carried into the garage, or was the actual daycare in the garage. The pt appears to young to be crawling so getting a foreign body in airway might be hard. And kids are not normally in v-fib at this age ( I have had two in 17 years that were in v fib).
    I am probably thinking way too much into it as this is a dosing question
    And a great way to make sure you don’t ever lose your ability to have a length based tape, or have a back up…..Use colored duct tape onto the stretcher at various locations and then laminate and tape the color dosing chart to the wall of the unit. Just an idea.

    1. Dave,
      Great tips! Love the tape idea. Indeed the garage is the daycare, and not a good one. The main focus for this post, and others I’m writing stems from a tale told to me about a medic who spent 45 seconds rifling through their bag for the braslow tape while their Paramedic student assessed and dosed the patient. Talk about awkward.
      Just a little something to get the ol’ brain juices flowing this morning.

  4. I'll regret this because I'm bad at guessing anyone's weight from a picture but I'm feeling saucy this morning. Kid looks about 15lbs so thats 6.82kg round it up to 7kg to make things easier. So here in the backward Chicago EMS systerm we would have- defib@ 14J initially (2J/kg) then defib@ 28J (4J/kg) Epi 1:10,000 @ 0.07mg Lido @ 7mg followed by repeat doses 3.5mg up to a max of 100mg. Now tell me that the kid actually weighs somehting like 30lbs so i can feel bad about myself.

  5. That's about an 8 lb rug rat (I have some so I can call them that)=4kg est.
    We'll start with shock at 8 j and go right into CPR
    IV's up so 1:10,000 Epi .04 mg, reevaluate for 4J/kg if needed defib.
    And so on…………
    But I noticed that you said she was in a garage at a daycare. Was the patient carried into the garage, or was the actual daycare in the garage. The pt appears to young to be crawling so getting a foreign body in airway might be hard. And kids are not normally in v-fib at this age ( I have had two in 17 years that were in v fib).
    I am probably thinking way too much into it as this is a dosing question
    And a great way to make sure you don't ever lose your ability to have a length based tape, or have a back up…..Use colored duct tape onto the stretcher at various locations and then laminate and tape the color dosing chart to the wall of the unit. Just an idea.

  6. Dave,
    Great tips! Love the tape idea. Indeed the garage is the daycare, and not a good one. The main focus for this post, and others I'm writing stems from a tale told to me about a medic who spent 45 seconds rifling through their bag for the braslow tape while their Paramedic student assessed and dosed the patient. Talk about awkward.
    Just a little something to get the ol' brain juices flowing this morning.

  7. Angelo,
    Thanks for reading and even more for weighing (hahaha..cough…no? weighing? I thought it was funny) in on this new topic.
    Those of us with kids have an advantage in these scenarios not unlike someone with a family member with Down's Syndrome can assess that population better. As more folks chime in and we see a variety of responses, let's focus on how slightly the doses will vary and remember that all our math boils down to us guessing their weight to begin with.

  8. I carry my own Broselow tape in my pocket. I have not had any employer I trust enough to have it when I need it, and that would be when I realized that that was what was missing from the bag.

    Some employers only used the Pedi Wheel, but you point out the big problem with that approach – you have to know the weight for it to be more useful than a Frisbee. I prefer the Frisbee – it is much more versatile.

    I think I should pick him/her up, have him/her pee on me, and say That’ll do pig.

  9. After first making sure the childs airway was secure, i’d guess she weighs between 10-15 lbs (use objects (bag of flour or another child about the same size that they KNOW the weight of for comparison), but you stated its a home daycare. Almost all homes have some form of scale. Get the homeowner to provide a scale, step on it with her, then subtract your weight.

  10. I carry my own Broselow tape in my pocket. I have not had any employer I trust enough to have it when I need it, and that would be when I realized that that was what was missing from the bag.

    Some employers only used the Pedi Wheel, but you point out the big problem with that approach – you have to know the weight for it to be more useful than a Frisbee. I prefer the Frisbee – it is much more versatile.

    I think I should pick him/her up, have him/her pee on me, and say That'll do pig.

  11. After first making sure the childs airway was secure, i'd guess she weighs between 10-15 lbs (use objects (bag of flour or another child about the same size that they KNOW the weight of for comparison), but you stated its a home daycare. Almost all homes have some form of scale. Get the homeowner to provide a scale, step on it with her, then subtract your weight.

  12. A 8kg child? But I’m not really sure. She’d get shocked at 16kj x1 and 32kj x2. Haven’t learnt pead doses for adr yet.
    Also, what is a Broselow tape?

    1. Here is a link to a broselow tape product. Handy if the child in question is height to weight ratio compliant, which neither of my children are. But, a wonderful tool to fall back on if you can’t do the calculations in your head at the scene.

      Field guides are good resources for reading up while on standby or when stumped, but should only be used for reference, not in place of knowing your protocols.

  13. A 8kg child? But I'm not really sure. She'd get shocked at 16kj x1 and 32kj x2. Haven't learnt pead doses for adr yet.
    Also, what is a Broselow tape?

  14. Here is a link to a broselow tape product. Handy if the child in question is height to weight ratio compliant, which neither of my children are. But, a wonderful tool to fall back on if you can't do the calculations in your head at the scene.

    Field guides are good resources for reading up while on standby or when stumped, but should only be used for reference, not in place of knowing your protocols.

  15. I just saw a kid just like that in the ED today. My guess, even though I can’t pick the little stinker up, is about 7k… so the Epi does is 0.14ml (using 0.2 ml/kg of epi 1-10:000) And shock at 14 joules, then 28 joules….and on and on and on…

  16. I just saw a kid just like that in the ED today. My guess, even though I can't pick the little stinker up, is about 7k… so the Epi does is 0.14ml (using 0.2 ml/kg of epi 1-10:000) And shock at 14 joules, then 28 joules….and on and on and on…

  17. approx 3-3.5kg (I’ll assume 3)

    defib 6J follwed by 12J if needed
    epi .03mg IVP
    amiodarone 15mg IV

    ET tube size of baby’s pinky

    DIESEL

  18. approx 3-3.5kg (I'll assume 3)

    defib 6J follwed by 12J if needed
    epi .03mg IVP
    amiodarone 15mg IV

    ET tube size of baby's pinky

    DIESEL

  19. I like this post mate. Is this going to be the start of a new series?

    Sorry I am late to the party though, but I would just turn straight to my JRCALC pocket book (The UK ambulance service offical guidelines), and turn to the child age guidlines and look at the 3 month child page.

    That tells me that the little one gets a 3.5mm, 11cm tube (If I cannot maintain an airway with other more basic means), defib at 25j (biphasic), adrenaline 1:10,000 60mcg (0.6ml), Amiodarone 30mg (1.0ml) IV/IO and fluid bolus of 120ml (if required).

    I know it seem like a cop out not knowing all the ratios and doses of the top of my head, but in a situation like this, and without another paramedic to double check my own workings out based on memory (either working alone on the car or with an ECSW), I dont think I would trust myself. Therefore I use what I have in my pocket!!

    But the best thing about this post is that it made me go back to my books and read up on things that I should know from the top of my head too. Thanks

  20. I like this post mate. Is this going to be the start of a new series?

    Sorry I am late to the party though, but I would just turn straight to my JRCALC pocket book (The UK ambulance service offical guidelines), and turn to the child age guidlines and look at the 3 month child page.

    That tells me that the little one gets a 3.5mm, 11cm tube (If I cannot maintain an airway with other more basic means), defib at 25j (biphasic), adrenaline 1:10,000 60mcg (0.6ml), Amiodarone 30mg (1.0ml) IV/IO and fluid bolus of 120ml (if required).

    I know it seem like a cop out not knowing all the ratios and doses of the top of my head, but in a situation like this, and without another paramedic to double check my own workings out based on memory (either working alone on the car or with an ECSW), I dont think I would trust myself. Therefore I use what I have in my pocket!!

    But the best thing about this post is that it made me go back to my books and read up on things that I should know from the top of my head too. Thanks

  21. approx 3-3.5kg (I'll assume 3)

    defib 6J follwed by 12J if needed
    epi .03mg IVP
    amiodarone 15mg IV

    ET tube size of baby's pinky

    DIESEL

  22. I like this post mate. Is this going to be the start of a new series?

    Sorry I am late to the party though, but I would just turn straight to my JRCALC pocket book (The UK ambulance service offical guidelines), and turn to the child age guidlines and look at the 3 month child page.

    That tells me that the little one gets a 3.5mm, 11cm tube (If I cannot maintain an airway with other more basic means), defib at 25j (biphasic), adrenaline 1:10,000 60mcg (0.6ml), Amiodarone 30mg (1.0ml) IV/IO and fluid bolus of 120ml (if required).

    I know it seem like a cop out not knowing all the ratios and doses of the top of my head, but in a situation like this, and without another paramedic to double check my own workings out based on memory (either working alone on the car or with an ECSW), I dont think I would trust myself. Therefore I use what I have in my pocket!!

    But the best thing about this post is that it made me go back to my books and read up on things that I should know from the top of my head too. Thanks

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>