At some time in their careers every provider experiences it; the “Pucker Factor.” That moment when you feel like your skills and knowledge are inadequate for the task in front of you. This is especially true when faced with pediatric emergencies. They require specialized knowledge and training, and can be highly emotional for the patient, their families, and those called upon to provide critical care. However, with the right preparation, providers can reduce the pucker factor and effectively manage pediatric emergencies. Below are some tips for reducing anxiety when dealing with pediatric emergencies:
Start with the basics
First and foremost, infants and children are not “small adults.” Their physiology and responses to critical stimuli are very different. The well-prepared provider understands those difference and is prepared to respond accordingly.
The provider must have a solid understanding of the basics. Such concepts as knowing normal pediatric vital signs, developmental milestones, and common pediatric conditions help assess whether the child is in extremis or simply a routine medical occurrence.
Seizures are a perfect example. Finding a post-ictal, diaphoretic, and febrile infant with a recent history of flu-like symptoms and seizure-like activity lasting a few seconds may indicate a simple, febrile seizure and not something more nefarious.
Practice, practice, practice
We spend a great deal of time practicing skills like CPR, chest decompression, and intubation. Yet these skills are predominantly adult-oriented. Even during basic CPR classes, child and pediatric skills are taught near the end. Fortunately, pediatric emergencies are rare. Unfortunately, that means the skills involved are not readily employed during a daily patient load. Practicing pediatric skills should be a priority. Using Gordon Graham’s analogy of “Low Frequency-High Risk” the provider needs to seek out opportunities to hone the less used skills. Because when they are needed, there is no substitute, and the risk of failure can be great.
The more experience healthcare providers have in managing pediatric emergencies, the more confident and competent they will feel. Lab simulations and hands-on scenarios are essential in developing confidence during pediatric emergencies.
Effective communication is a constant theme when managing any emergency, but it is especially important in pediatric emergencies. Providers need to communicate clearly and calmly with the patient’s family and other members of the healthcare team. They should apply age-appropriate language when speaking directly to the patient.
Involve parents and caregivers
Listen to the parents. Almost all pediatric intensivists will affirm that no one knows the patient better than the parent. Parents and caregivers can be valuable allies in pediatric emergencies. They can provide important information about the patient’s medical history and help calm the patient.
Engaging the parents or guardians and explaining what is occurring in terms they understand can ease both theirs and the patient’s anxiety and can often provide you with a roadmap of where to begin.
Use appropriate equipment and medications
Pediatric patients require specialized equipment and medications. In the early days, medics were taught to titrate adult medications and procedures to fit children. The complex mathematical equations as well as the tremendous potential to over or under dose led to heightened anxiety.
Today, specially packaged medications and age or length-based measuring devices like the Handtevy system make calculation and administration of medications and procedures much easier. Additionally, appropriately sized tools and equipment leave little room for error when faced with a critical situation.
Focus on comfort measures
Almost all emergency providers agree, “a crying baby is a good baby.” But a crying baby can also mean the child is in some level of discomfort. Providers should prioritize comfort measures, such as proper positioning and emotional support. These simple techniques can help reduce the patient’s distress and make the situation more manageable for everyone involved.
Approach them with confidence
Pediatric emergencies can be challenging, but with the right preparation, healthcare providers can reduce the “Pucker Factor” and effectively manage these situations.
Providers should have a solid understanding of pediatric basics, practice pediatric skills regularly, communicate effectively by involving parents and caregivers, use appropriate equipment and medications, and prioritize comfort measures.
The First There First Care & Gathering of Eagles Conference puts great focus on development of pediatric related skills and knowledge. Opportunities to learn from the experts like Dr. Peter Antevy, creator of the Handtevy system can provide the attendee with firsthand knowledge regarding managing pediatric patients. By making pediatric management a priority the provider can increase their confidence when faced with a critical child and provide better, more efficient care, while reducing the often-related anxieties.