The Message is Resonating
January 2022 will be 12 years since the founding of Handtevy, inspired after a 10-fold medication error I had made, yet wasn’t aware of at the time. I’ll never forget that Sunday morning in the ED when I opened up the printer tray to grab a clean 8.5” x 11” sheet of paper with the hope of becoming a more capable doctor, who was entrusted by parents to treat their sick and injured children. I paced in the ED racking my brain on how to overcome the difficulties of medication dosing during high stress moments, until it hit me like a ton of bricks, “Just do what Bob Hickey used to do.”
Robert (Bob) Hickey, MD is a pediatric emergency medicine physician at the Children’s Hospital of Pittsburgh, and a renowned resuscitation research scientist. Open up your PALS text and Bob’s name is front and center as one of the authors. I was fortunate enough to have Bob as a mentor for 3-years, from 2002-2005, during my fellowship in Pittsburgh. So what did Bob do? Bob used the child’s age to estimate the ideal body weight and then quickly determined medication dosing, and boy did he make it look easy. A code would roll through the door and there was Bob at the head of the bed calmly running the show, without even a tinge of anxiety. I always thought that if I were to hook Bob up to the monitor at that moment that his heart rate wouldn’t even break 60!
On that Sunday morning, on that blank sheet of paper, I began to channel Bob’s teachings and wrote down 5 ages, 1-3-5-7-9. I then searched the literature for the few papers that listed formulas for predicting ideal body weight based on age and began to run the math. It nicely worked out to 10-15-20-25-30 Kg. From there, I listed the few medications that I’d potentially use in a code; Epinephrine (1 mg/mL and 1 mg/10mL), Atropine (yes I’m old), Bicarb (repeat the old comment), D25 and Normal Saline. I then did the calculations and wrote down the volumes for each drug, and that was my ah-ha moment!
The “ah-ha” Moment: The above image is replica of the initial form I drew up that morning in the ED.
Using age to determine weight was such an important concept, but I didn’t fully understand why at the time, yet it became very clear over the ensuing years, particularly as I entered the field of EMS. Age allows for the pre-planning phase – to begin drug dosing prior to arrival on scene – and thereby bringing the anxiety down to a manageable level. EMS clinicians could then stay on scene and treat the time sensitive conditions such as seizure, hypoglycemia, and cardiac arrest. This simple series of steps allowed EMS clinicians, who knew they could do better, and finally had the permission, to do so.
We are finally there. The work you have done as Handtevy instructors has helped send the message loud and clear; “We can treat kids like little adults,” meaning we can treat pediatric patients with the same high quality, confidence, and care that we treat their adult counterparts. The message is resonating as more and more communities across the globe begin to change a culture that’s been detrimental to outcomes and impeded innovation. Together, we have made a huge impact in the care children receive during the time they need it most and for that we thank you! We have so much work left to do and we’re excited about what the future holds. From my team to yours, we wish you a happy and healthy holiday season and new year!
Peter Antevy, MD
DISCLAIMER:Pediatric Emergency Standards Inc. does not make clinical or medical decisions. The Handtevy System is intended to be utilized as a guide only. Provider’s experience and training should be the final determinant of clinical treatment decisions.