Broselow Tape
Potential Underdosing
ACNP/Flight Nurse, Carolyn Nieman recently
discovered that sometimes motherhood is the mother of invention. Ms.
Nieman, who works as a flight nurse specialist for Metro Life Flight
and is a member of the CASE faculty. Three years ago, while watching
her thirteen-year-old daughter and ten-year-old son perform at a school
concert, she first thought of the idea that the Broselow Tape may
underestimate children's size. Soon afterward, she began devising a way
to improve on the “Broselow Tape” method traditionally used
in emergency medical situations involving children requiring
resuscitation. The method is used to estimate medication dosing and
equipment sizing based on a child’s age and body size. “I
always thought my kids were normal size, but that night they seemed so
much smaller than everyone else on stage,” she says. “So
when I came to work, I started thinking there’s no way that the
Broselow Tape can be accurate anymore, and it became more clear to me
everywhere I went that kids seemed bigger and bigger.”
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Environmental Cues
Situational Awareness
Situational awareness is a key factor in
preparedness for emergencies. The range of sensory cues identified in
this observational and interview study include six categories of cues.
They are visual, acoustic, vibration, air current, thermal, and smell.
Examples of sensory cues identified include VISUAL: observation of
treatment provided by first responders, wind direction, fireworks being
launched into the air, shadows of poles and trees that were not
themselves visible, blinking lights that might indicate the presence of
obstruction of "steady" light sources, damage to vehicles and
buildings, the inability to visualize, monitor power failure,
estimating the size of confined spaces; ACOUTSIC: inability to hear
change in breath sounds (thus choosing to electively place chest tube
for 50 mL hemothorax), noise produced by generators, fire trucks and
extrication tools, rotor sound; THERMAL: air temperature and
temperature of fluids during fluid resuscitation; SMELL: smell of jet
fuel (potential emergency condition) versus jet exhaust (time signal on
close approach). The sensory cues identified will be used to develop a
"synthetic natural environment" to conduct training of advanced
practice nurses and to conduct clinical research using simulated
patients under a wide range of environmental conditions.
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