Years ago I carried an emergency backpack with me. It was a present, looked really professional and cool but it was so huge that there was nearly no space for additional luggage in my car trunk when the backpack was placed there. It was stuffed with a lot of pricy tools as a pulsoxymeter, a laryngoscope, ET-tubes, larynx-tubes, O2-tank, Ambu-bag (Mark V), Samsplints, and so on.
After a while two things happened: first of all I became Dad of my first child (a daughter – today I´m the proud dad of four great kids). Belive me, I didnt even start arguing with my wife about the importance of an emergency backpack which was so big that there was not enough space to carry our baby buggy. Not talking about the missing space for any additional luggage. The second thing was that I realized that it was a lot of really booring work to keep track of the f***ing expiration dates of over 100 items. Last but not least storing drugs in a car at temperatures from -15°C in the Winter to 40°C and more in the summer isn´t the best idea too.
So I decidet to make a radical cut and removed my emergency-equpiment from my car. I didn´t carry anything more than the little first aid box which is required by law in Austria this times. I did so for eight years till my second child (a son) broke his arm really bad at a birthdayparty at the hous of a good friend in the countryside. The good thing: Ursula (my friend) is a veterinarian, the bad thing: I sedated my son with veterinary Ketamine (250ml bottle) and had to use a i.v. line usually used for horses. Dont worry – it worked well.
After that I realized that there was a need for carrying emergency-equipment beyond the little first aid box (has to be carried in any car in austria – required by law) with me.
I reflected upon it dozends of times and developed my personal emergency-equipment to carry with me. It had to be small and versatile. I wanted only items in it which I could use without the need of monitoring devices. And it had to be small enough to carry it with me in my backbag, shoulder bag, diaper bag and so on.
Here it is:
A simple click box. I own 3 identical ones. One placed in my car, one in my everyday shoulder bag and one at home. This makes it easy to replace the drugs regularly (usually one unit contains 5 vials – very near to the amount you need to stock up three sets) and keeping track of the expiration dates. The vials are placed in foam-material which I bought at the local hardware store and cutted in shape.
- 2 10ml vials saline 0.9%
- 1 3ml vial Midazolam 5mg/ml
- 1 5ml vial Flumazenil 0.1mg/ml
- 1 4ml vial Ondansetron 2mg/ml
- 1 2ml vial S-Ketamine 25mg/ml
- 1 1ml vial Epinephrine 1mg/ml
- 1 1ml vial Ephedrin 50mg/ml
- 1 2ml vial Nalbuphin 10mg/ml
- 1 4ml vial Dimetinden 1mg/ml
- 1 2ml vial Sugammadex (a leftover – removed after taking the pictures)
So I can treat anaphylaxis, asthma, perform a procedural sedation, provide analgesia, prevent nausea and vomiting (I always apply Ondansetron before using S-Ketamine or opioids in emergency situations) in a very safe manner.
- 2 5ml syringes
- 1 iv line 20G (flow rate 61 ml/min)
- 1 iv line 18G (flow rate 100 ml/min)
- 1 back check valve (with luer lock for the iv lines)
- 1 Canulla Fixation Dressing (Curagard SP – this one keeps iv lines better in place than other ones I know. Very adhesiv, really smart design – omega shaped)
- 4 band-aids (as you know, in real life there is nearly nothing requested more often from a physician than a band-aid)
I´ve used this box a lot of times till today. One life could definitly be safed with this minimalist equipment. I was able to treat an severe anaphylactic reaction after a wasp sting in a public swimming bath two years ago. Applying half of the epinephrin 1 minute after the sting intramuscularly and the rest in little boluses iv kept the women alive till the helicopter arrived. Having two iv lines placed before the veins collapsed simplyfied the further management.
What do you think? Any further suggestions? What can be made better? I´d love to read your comments.
Kostja Steiner is Anesthesiologist, Intensive Care Doc and Emergency Physician in Graz, Austria
We have teamed up with APLS to share the videos from their Paediatric Acute Care Conferences. These videos have never been open access before, so if you weren’t able to attend the conferences, then now’s your chance to catch up.
Susie Piper has been the Director of Paediatrics and Child Health for the Illawarra Shoalhaven Local Health District since 2012. She graduated from UNSW in 1990 and trained as a paediatrician at the Sydney Children’s Hospital and the Children’s Hospital at Westmead over the next ten years, including a six month stint in Tanzania during the Rwandan refugee crisis. With an interest in ambulatory care and ‘hospital in the home’, Dr Piper worked at Wyong Hospital and Campbelltown Hospital prior to coming to Illawarra, where she helped to establish a Paediatric Assessment Unit that aimed to treat kids locally and avoid hospital admission if possible. Dr Piper is hoping to establish similar models of care in Illawarra, particularly at Shellharbour Hospital.
Sandy Hopper is a dual-qualified Emergency Physician and Emergency Paediatrician, working at the Emergency Department of the Royal Children’s Hospital in Melbourne. He holds special interests in adolescent emergency medicine, mental health, observational and short stay medicine, and medical education.
In this talk they discuss managing acute illness in children without hospital admission.
Sandy Hopper and Susie Piper discuss ways of blurring the boundaries between in and outpatient care. They talk about why we admit kids to hospital, explore alternative options to admission and describe two examples of programs aimed at minimising kids time in hospital.
|Click to enlarge|
- Atrial rate 84 bpm
- Ventricular rate 42 bpm
- Regular atrial activity
- Regular ventricular activity
- 2:1 Pattern
- Normal (-33 deg)
- PR - Normal (~200ms) - when conducted
- QRS - Normal (100ms)
- QT - 450ms
- Nil significant changes
- Relatively large T waves in leads II, aVF, V3 when compared with QRS voltage
- 2:1 AV Block
The patient was admitted under the cardiology team, nil reversible causes were identified. During monitoring the patient had runs of Mobitz II 2nd Degree AV block and underwent an uneventful pacemaker insertion.
References / Further Reading
Life in the Fast Lane
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.