Improved speed and accuracy of calculations with a programmable calculator in pediatric emergency scenarios

Article Abstract:

Because children vary widely in age, weight, and metabolism, these patients present special difficulties to physicians in emergency care situations. A particular problem is the adjustment of types and doses of fluids and drugs. Experience allows specialists in pediatric emergencies to handle these adjustments and calculations, while other physicians may have more difficulty. Guidelines are available in standard pediatric reference books and have also been presented in computer programs and in a programmable calculator. The effectiveness of using a programmed calculator, which provides prompts to the user, was compared with standard methods using a textbook and a regular calculator. The calculator provides guidelines for types of fluids and medications as well as performing calculations. Fifty-eight physicians, residents, and medical students took two written tests, one for each method, that presented three typical pediatric emergencies. Significantly less time was needed to complete the tests using the programmed calculator. The answers obtained with the programmed calculator were 98 percent accurate, compared with 73 percent accuracy using traditional methods. Third-year residents were significantly faster using standard methods. The time needed by first-year residents and physicians significantly decreased compared with third-year residents the programmed calculator was used. The programmed calculator allowed all participants to provide quick and accurate directions regardless of education level. The results illustrate the difficulties faced by physicians when dealing with pediatric emergencies and indicate the usefulness of the programmed calculator in such situations. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Information management, Pediatric emergencies, Medical protocols, Programmable calculators

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Pediatric extracorporeal membrane oxygen: the time for anecdotes is over

Article Abstract:

Extracorporeal membrane oxygenation (ECMO) is a technique of oxygenating the blood using an artificial membrane located outside of the body; it is used to treat infants with severe lung disease. One disease entity is acute respiratory failure (ARF), which in children is associated with a death rate of approximately 60 percent. Because the mortality rate is so high, it is not surprising that ECMO is occasionally used for this group of pediatric patients. Although recent research articles have indicated that ECMO may be beneficial, it may not represent an advance in treating these children. The use of ECMO in adult ARF patients has been extremely discouraging, with as many as 90 percent of the patients eventually succumbing to the disease. The technique has been virtually abandoned for adults, but a group of new studies in neonates has brought the technique back to the attention of the medical community. One problem is that ARF is not a single disease, but most likely a group of similar diseases and conditions of the lung. Even the mortality of ARF is not accurately known. It is time that ECMO be properly evaluated by a carefully constructed clinical test. To perform such trials, some children with ARF who perhaps could gain benefit from ECMO will most likely have the method withheld from them to investigate its value. This raises, of course, ethical issues which must be considered. There is also the concern that such studies are in themselves inappropriate, because researchers are distracted from the larger issue, namely that the actually physiologic mechanisms of ARF remain unknown. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Ethical aspects, Blood oxygenation, Extracorporeal, Extracorporeal membrane oxygenation, Respiratory distress syndrome, editorial

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