Top 5 pediatric medical care questions
Peter Antevy, winner of the Anderson Award, answers the five questions he is asked most often at the 2017 Gathering of Eagles
DALLAS — Peter Antevy, MD, a pediatric emergency medicine physician best known for his development of the Hantevy Method for pediatric medication administration, gave a number of interesting talks at the 2017 Gathering of Eagles.
On the second day of the conference, Antevy was awarded the Ron J. Anderson Award for the significant impact his work within the field of pediatric EMS has had on the industry. Afterward, he presented on the top five challenges in prehospital pediatric medical care. His session, streamed on Periscope, was chock full of information including the following memorable quotes and key takeaways.
Memorable quotes on pediatric care
"If you have a BVM, chest rise, good saturation and you think you’re ventilating the patient OK, stick with that."
"It’s really hard to screw the King tube up, you just shove it in and it goes in the right spot."
"At the end of the day, BVM is still king."
"There is going to come a day where if you document a pain score greater than '5' and don’t give a dose of a pain medication, then you won’t get paid."
"With morphine … the pain finally goes away after you transfer care and the doctor gets all the credit. We don’t want to do that."
"Why shouldn’t we all use D10 cradle to grave?"
Key takeaways on pediatric care
Antevy’s talk was well organized and able to address the following questions:
1. What’s the best pediatric airway option?
A BVM with good placement and vitals is the best option; however, if necessary, Antevy is also a fan of supraglottic airways including the LMA, King LT and iGel. He uses all three across the various EMS systems he provides medical direction to.
2. What should EMS use for pediatric pain control?
Antevy's first focus was the growing trend toward meaningful use. EMS agencies should expect to provide medication to children complaining of pain regardless of how far away the receiving facility is located. Otherwise, they will eventually pay a financial penalty.
Most agencies likely use morphine, fentanyl, dilaudid or ketamine. Antevy argues that fentanyl and ketamine are the leaders for pediatric pain control since morphine takes 25 minutes for the patient’s pain levels to decrease.
Antevy reminded the audience of the dead space that exists in the MAD device when administering nasally which traps 0.1 mL of medication, which can significantly impact the volume of medication a pediatric patient receives.
3. What should EMS use for pediatric seizure control?
Most agencies now use midazolam over lorazepam and diazepam because it’s fast, can be used via any route of administration and has very few active metabolites. That said, recent research suggests, and Antevy agrees, that intramuscular administration is preferred over IV or rectal.
4. How should EMS treat hypoglycemia?
Another recent publication out of Oregon suggests that hypoglycemia protocols vary widely by agency. Antevy received a round of applause when suggesting that everyone use D10 for all patients, regardless of the patient's age.
5. Should EMS withhold fluids in kids?
A single NEJM article on children with malaria in sub-Saharan African recommended against bolusing children that are not in shock. Most other research suggests that there is no benefit to withholding fluids, something Antevy agrees with.
Learn more about pediatric assessment
Antevy recently discussed these five questions and other pediatric assessment and care topics on the Inside EMS podcast:
After listening to the podcast, check out these articles on EMS1:
- Pediatric IOs: 5 things I didn’t learn in paramedic school
- How to use OPQRST as an effective patient assessment tool
- Pediatric patient ABCs: 7 tips for EMTs and paramedics
- EMS leader’s 8-step guide to excellent pediatric care
- 3 things paramedics need to know about seizures and respiratory compromise
- How well do you know pediatrics?
- The critical pediatric patient: Test your knowledge
- Pediatric trauma assessment and treatment tips