Pediatric Drug Dosages

Dr. Peter Antevy is a featured speaker at EMS World Expo, November 9–13 in Nashville, TN. Visit EMSWorldExpo.com for more information.

Peter Antevy, MD, never intended to reinvent the wheel. He was just looking for a more efficient, effective way to determine drug dosages for his pediatric patients.

What he eventually came up with—what would become the Handtevy method—bears an obvious resemblance, at least in principle, to the Broselow Tape. But they’re not the same thing. As Antevy puts it, where the Broselow Tape was a leap forward when it debuted in the mid-1980s, the Handtevy method is the next step in the evolution of pediatric emergency medicine.

Antevy is founder and CEO of Pediatric Emergency Standards, a pediatric emergency medicine physician at Joe DiMaggio Children’s Hospital in Hollywood, FL, and medical director of Davie Fire-Rescue, associate medical director of Miramar Fire Rescue and medical director of the EMS Division of Broward College. When he was taught, he learned to use age, rather than height, to determine weight and proper dosages in pediatric patients.
Doctors are taught in medical school to give the milligram dose, says Antevy. But that’s not what the nurse needs. So, nurses are often forced to convert milligrams to milliliters on the spot, in the middle of a code, wasting valuable time and risking a miscalculation.

And miscalculations do occur. Medication dosing errors occur in up to 17.8% of hospitalized children. In EMS, the rate is even worse. According to a 2004–06 study conducted across eight Michigan EMS agencies, medication dosing errors occurred in nearly 35% of cases.¹

“Wouldn’t it be nice if the doctor walks in and says, ‘I need 2 ml of amiodarone. I need 2 ml of epinephrine 1:10,000.’ And the nurse would say, ‘OK!’ That’s where I realized that people were going wrong. People are hell bent on finding out what the weight is of the child; it’s not the weight that we really need, it’s the dose in milliliters that we really need,” explains Antevy.

Rather than using the height or length of a child to determine their weight, Antevy began by breaking down the common age span of pediatric patients into five easy categories: 1, 3, 5, 7 and 9. Then, using a formula that’s been used in pediatrics for years, he came up with the average weights of those ages. They broke down into five categories, too: 10, 15, 20, 25 and 30 kg. (Here’s where you can start to see the rationale behind the name “Handtevy.” Hold up a hand and tick those numbers off on your fingers.) Finally, he came up with eight drugs he felt were most important to know dosages of quickly during a pediatric code, and he filled in the volumes. Ultimately finding the volumes was just a function of moving decimal points or basic multiplication, he says, and a light went on.

“Now, here I am in the ER, and the next time a code comes in, I tell the nurses, ‘This kid’s 3 years old, so he weighs 15 kg—let’s give 1.5 ml of epi 1:10,000, draw up 3 ml of atropine and give me 30 ml of D25.’”

He may have developed Handtevy for the ER, but as an EMS medical director he quickly realized how beneficial it could be in a prehospital setting as well.

Where Antevy’s at now with the Handtevy method has come a long way from counting on fingers. It’s an agency-specific system that provides everything needed in the field. Pediatric Emergency Standards offers the Handtevy Pediatric Box, which comes stocked with equipment or unstocked, depending on agency preference. To conform to PALS guidelines, Handtevy includes a length-based system for determining dosages, which makes it a true hybrid system. In each box there are seven pouches or bags for the following ages: under 1, 1, 2, 3–4, 5–6, 7–8 and 9–13 years old. Inside each pouch are the proper age- or length-based equipment items, meaning you have the right-sized IV catheter, suction catheter, OPA, NPA, ET tube, blade, etc.

The customization in the Handtevy Pediatric Box comes from its medication guide book, which includes a comprehensive review by a pediatric emergency room physician and pediatric pharmacist of the specific department’s protocols. The box also includes an electronic version of the book to be put onto the agency’s ePCR.

Most important,” Antevy says, “the kit comes with access to our team of highly trained physicians and nurses. We pride ourselves on making sure things are correct.”

He and his team review an agency’s protocols and medications to create tailor-made Handtevy boxes. And if an agency updates its protocols, Antevy says it’s a simple matter to update the print and electronic versions of the books included with the kit. Similarly, in acknowledgement of the issue of drug shortages, the customized books in the Handtevy boxes include alternate drugs and their appropriate dosages.

To learn more, visit www.Handtevy.com.

Reference
1. Hoyle JD, Davis AT, Putman KK, Trytko JA, Fales WD. Medication dosing errors in pediatric patients treated by emergency medical services. Prehosp Emerg Care, 2012 Jan–Mar; 16(1): 59–66.