Thank you all very much for the help you gave me regarding my Pediatric project. If you do not mind I have another question.
In the Scottish Ambulance Service we do not have IO access. My Training Officers are once again trying to 'get' us this extra skill, but they have been trying for close on 10yrs without much success!!!!!. Due to a childs compensatory abilities I would imagine that gaining IV acces would be very difficult, even more so if you are not performing that 'skill' on a regular basis. Even if we gained IV access we can give nothing in the line of pain relief to a child, we are not permitted to give Naloxone to anyone under 10yrs of age, from what I have read and I know i could well be wrong here, why not?. Anyway that is not why I am writing this, my question is, in a Cardiopulmonary arrest the only chance we have of giving drugs would be ET. On the PALS course I did they told us not to bother with 1:1000 as the chances of us been able to draw up the drug fron the vial in a Pediatric emergency (hands shaking etc) would be nil as we would probably lose half of it, I can go with that, so that leaves us 1:10:000. I talked with the Consultant who directed my PALS course and she said the maximum dosage down the ET tube for any child should be 16mls, my calculations then tell me that after 4yrs of age we can do nothing, as the initial dose would be 1.6mls followed by 16mls. There are a number of reasons this leaves me confused and frustrated. The dosages for ET are supposed to be higher than IV nad IO. Surely the amount of fluid you can put down an ET tube in a 14yr old must be more that that of a Newborn. So the maximum age I could hope to treat in an arrest would be 4yrs of age. I know that reversing asytole in a kid is almost a non starter, but surely no matter what the probable outcome you have to walk away with the knowledge that you have done the best you can. I dread the day I am confronted with a cardiac arrest in a child, it is one thing been a harrowing experience it's another not been able to know in your heart you did your best because I don't know what is supposed to be my best!!!.
Sorry to go on but I hope you can understand where I am coming from. If my bosses could see this I would be hung out to dry, but it is not them that would have to deal with it.
Any help or advice would be gratefully recieved
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