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It’s 3:00 a.m. in the small community hospital where you are moonlighting for the first time. Your thoughts are interrupted by a page from triage informing you that a four-year-old female was just brought in by parents after being struck by a car while riding her bike. You quickly mobilize your team and then you realize something. You never reviewed the pediatric resuscitation equipment prior to the start of your first shift. As the patient is brought into the room with agonal respirations and an obvious head injury a nurse cracks open the peds cart and you start to shuffle through the equipment looking for your crutch. You quickly realize that they do not have a peds pharmacy book or a Broselow tape in the cart. Then you remember what might turn out to be the best 99 cents you’ve ever spent and fire up your iPhone. Within 10 seconds you’ve launched Pedi Safe by iAnesthesia LLC.

The opening screen of Pedi Safe is broken down by weight with kilograms listed in bold along with pounds in smaller print. Tapping on a given weight opens a secondary window with several sections within the window. The first section is vital signs listing normal ranges including tidal volume. This is followed by airway equipment measurements including LMA’s. The next four subsections fit together nicely and include: RSI pretreatment meds, induction agents, paralytic doses, and finally sedation meds. The only real fault I see here is that the sedation medications don’t differentiate conscious sedation dosages from vent sedation dosages. A minor gripe but something that could pose a problem if used improperly.  

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The iPad version (above) is customized for the larger screen and it also has a landscape mode. The benefit to this rotated landscape view is that you can easily see all of the weights on the left side of the screen while viewing the corresponding medications for a specific weight. This allows you to quickly switch between different dosages.

 

Airway is then followed by resuscitation medications starting with a section on IV fluids, including boluses, maintenance, deficits, and blood. Just as in real life when IV fluids and blood aren’t enough, the next section is cardiovascular support including pressers and vasodilators. Again in a mirror of reality, the final section is cardiac resuscitation medications and electrical intervention.

All of the interventions are in bold (i.e. Epinepherine) with tips such as endotrachial dosing or how quickly to push the medication in smaller type underneath. On the right side of the screen are the dosing ranges in bold on top with weight-based dosing subdued below it.
At a cost of $.99 (may increase to $2.00 by press time), the Pedi Safe app also gets you an iPad-specific version which is a nice bonus.  

I work in an adult ED with a children’s hospital right across the street, so I rarely see children other than adolescent trauma and newborn deliveries. And while I have other apps such as PEPID that contain all of the same information as Pedi Safe, none of them do it in such an intuitive and elegant fashion. Pedi Safe doesn’t try to do everything for everyone. They have a very narrow focus which they’ve done a great job with. If I were going to add any constructive critique, it would be that I’d like to see an in-app calculator to more specifically dose medications when your kiddo is nicely placed between the weight categories. That being said, at the cost of a bottle of soda, this app is a no-brainer to keep tucked away on your iPhone or iPad for those Oh S#!t moments.

 

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