Most procedures performed in the emergency department (ED) do not require rapid selection of drugs and equipment. Although the majority of ED procedures are of an urgent or nonelective nature, the clinician usually has adequate time for the measurement of a patient’s weight, the selection of equipment, and the calculation of drug dosages required before performing a procedure. Examples include the suturing of lacerations, the reduction of fractures, and suprapubic aspirations.

Some procedures, however, do not afford the clinician the luxury of a preparation period. These procedures must be done immediately. Failure to act expeditiously can cause loss of life or limb. There is no time to obtain an accurate weight on a patient. Efforts spent in equipment selection and drug dosage calculation only exacerbate the lack of time. Anxiety produced when faced with this dilemma, as well as error from inaccurate drug dosage calculation and equipment selection, compounds the problem. An example is endotracheal intubation, which requires proper-sized laryngoscopes, endotracheal tubes, and suction catheters as well as medications for rapid sequence induction of anesthesia.

The advent of organized, educational, resuscitative efforts for adults (advanced cardiac life support [ACLS]) and children (pediatric advanced life support [PALS]) brought about attempts to solve drug dosage and equipment selection problems, as it became clear that this area of resuscitation was fraught with error and delays (1). The need to spend time addressing drug dosing and equipment selection in pediatric emergency situations is an added logistical difficulty not present in adult resuscitation, as drugs are usually packaged in prefilled syringes containing the standard resuscitation dose, and equipment sizes vary little. The sum total of the difficulties encountered increases the provider’s mental burden, referred to as the “cognitive load” of pediatric resuscitation (2). These logistical activities can detract from the provider’s “critical thinking time” and hence his or her ability to evaluate, synthesize, and prioritize information and make decisions, which are necessary for successful resuscitation management. To the extent that resuscitation aids can reduce the logistics of pediatric resuscitation by eliminating calculations for drug dosing, equipment selection, and other size-related therapy issues, such as ventilator settings and fluid therapy, care can be facilitated and efforts optimized. Table 6.1 compares various types of resuscitation aids and their relative merits.

Following is a description the Broselow tape and its application in emergent therapy. The Broselow tape is a length-measuring tape that estimates patient weight (Fig. 6.1A). Emergent drug dosages and drug volumes, as well as equipment, can be read directly from the tape. Studies have validated the accuracy of the tape in weight estimation for drug dosing (3) and for equipment selection (4). A more recent enhancement to the tape, referred to as the “Broselow-Luten system,” incorporates multiple additional medications and therapeutic information in various formats. In simulation studies, use of the system in common emergent situations has been demonstrated to reduce time and errors (5).

The child is measured in the recumbent position, the likely posture during critical care interventions (Fig. 6.1B). The tape is stretched from the crown of the head to the heel. It is not crucial to measure to the nearest millimeter, nor to



obsess over perfect straightening of the child. There are 11 “weight spaces,” including 3-, 4-, 5-kg zones and eight larger zones, ranging from a 6- to 7-kg zone to a zone spanning 30 to 36 kg. Each weight zone is assigned a color to distinguish it from the others. Drugs and other modalities incorporated into the Broselow tape are shown in Figure 6.2.