Pediatric Office Emergency Preparedness: An Intensive In-Office Training Curriculum.

OBJECTIVE: Preparation is vital to improve resuscitation outcomes for children presenting to the primary care office with emergent conditions. Previous literature has provided recommendations for medications, equipment, and skills necessary to provide appropriate care. Most studies thus far demonstrated offices are unprepared according to those recommendations. We sought to provide an intensive emergency training and preparation curriculum to local primary care pediatric offices to improve their emergency readiness. METHODS: Using a high-fidelity manikin, a simulation instructor team visited several offices and trained teams including physicians, nurse practitioners, nurses, medical assistants, front desk staff, and billing/management staff. Two emergency resuscitation simulations were performed per session with education after each scenario. The instructor team taught procedures, provided teamwork training, and provided feedback on medications, equipment, and resuscitation priorities. RESULTS: Eight primary care pediatric offices participated in the curriculum, 36 training sessions were conducted, and 229 staff were trained. Numerous issues with medications, equipment, teamwork dynamics, and pediatric emergency resuscitation were revealed. There was always significant improvement from the first to the second simulation in each session. CONCLUSIONS: Our intensive emergency training and preparation curriculum experience with local primary care pediatric offices highlighted discrepancies between the perceived level of office preparedness and actual experience during a simulated emergency. Office staff felt more prepared for an emergency after the training, and office medications and equipment were re-evaluated to provide a more efficient and effective resuscitation for their patients.

An unexpected diagnosis: simulation reveals unanticipated deficiencies in resident physician dysrhythmia knowledge.

Decision support tools are an important adjunct to medical resuscitation. We initiated a study comparing the use of the traditional code book method versus a computerized decision support system. However, appropriate use of the tools requires correct initial recognition of the dysrhythmia. Using simulation, numerous deficiencies were revealed regarding resident physician dysrhythmia knowledge. Most importantly, the rate of incorrect dysrhythmia recognition required discontinuation of the initial study, reorganization, and implementation of a modified study to achieve the study purpose.

Jet Injection of 1% buffered lidocaine versus topical ELA-Max for anesthesia before peripheral intravenous catheterization in children: a randomized controlled trial.

BACKGROUND: Peripheral intravenous (PIV) catheter insertion is a frequent, painful procedure that is often performed with little or no anesthesia. Current approaches that minimize pain for PIV catheter insertion have several limitations: significant delay for onset of anesthesia, inadequate anesthesia, infectious disease exposure risk from needlestick injuries, and patients' needle phobia. OBJECTIVE: Comparison of the anesthetic effectiveness of J-Tip needle-free jet injection of 1% buffered lidocaine to the anesthetic effectiveness of topical 4% ELA-Max for PIV catheter insertion. METHODS: A prospective, block-randomized, controlled trial comparing J-Tip jet injection of 1% buffered lidocaine to a 30-minute application of 4% ELA-Max for topical anesthesia in children 8 to 15 years old presenting to a tertiary care pediatric emergency department for PIV catheter insertion. All subjects recorded self-reported visual analog scale (VAS) scores for pain at time of enrollment and pain felt following PIV catheter insertion. Jet injection subjects also recorded pain of jet injection. Subjects were videotaped during jet injection and PIV catheter insertion. Videotapes were reviewed by a single blinded reviewer for observer-reported VAS pain scores for jet injection and PIV catheter insertion. RESULTS: Of the 70 children enrolled, 35 were randomized to the J-Tip jet injection group and 35 to the ELA-Max group. Patient-recorded enrollment VAS scores for pain were similar between groups (P = 0.74). Patient-recorded VAS scores were significantly different between groups immediately after PIV catheter insertion (17.3 for J-Tip jet injection vs 44.6 for ELA-Max, P < 0.001). Blinded reviewer assessed VAS scores for pain after PIV catheter insertion demonstrated a similar trend, but the comparison was not statistically significant (21.7 for J-Tip jet injection vs 31.9 ELA-Max, P = 0.23). CONCLUSION: J-Tip jet injection of 1% buffered lidocaine provided greater anesthesia than a 30-minute application of ELA-Max according to patient self-assessment of pain for children aged 8 to 15 years undergoing PIV catheter insertion.