home instrument/med kit for EM docs with kids

[CremasterFlash]

I'm a EM PGY2 looking to build a small kit for home emergencies. I have two little kids, totally healthy, no allergies. However, I want to make sure that in case something I'm not stuck with a lot of training and no tools. Do you guys have any realistic suggestions and brands that you trust? I'm considering, with varying degrees of insanity:

Cric kit
Jet ventilator
BVM
Epi-pen
Portable defibrillator
Pediatric Kelly clamp
Tourniquet
Splinting stuff
Broad spectrum abx
Pain meds
Suture kit
Antipyretics

Does anyone have experience making a kit like this? Brands that you like? Other suggestions? I realize that this is kind of over the top, but I live pretty far away from the nearest peds ED and the idea of one of my (or my neighbor's) kids circling the drain while I stand there seems to haunt me for some reason.

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[WilcoWorld]

Superglue - it's a slightly more thermogenic Dermabond. They sell it in single use packs, which are very nice to have on hand.

 

[CremasterFlash]

thanks, good call. i also find the dermabond pens that we use to be unnecessarily complicated and sloppy during the application process.

 

[e30ftw]

you can just get most of this stuff from your ER without too much fuss.

the rest you can buy from moore medical if you have a dea or med license.

the AED/jet ventilation stuff might cost you.

and +1 re: superglue. dermabond costs what $30? $2 of superglue in a reusable container that doesn't clump off in 10 seconds can close as much as 5 dermabond pens.

if you're going to get all that stuff you might as well have zofran odt, albuterol MDI and a pop-sickle for PO challenge..

 

[DeadCactus]

You don't need a pediatric ED, you need any ED. You need to get them into the hands of another capable provider so you're not the one trying to calmly and coherently work on your own child. To that end, you need interventions that need to be initiated before even the paramedics get there. I can't think of many diseases that qualify especially in kids. Anaphylaxis, dysrhythmia, tension pneumothorax, massive hemorrhage, asthma. So EpiPen, tourniquet, 16g needle, and albuterol MDI. AED would be reasonable. A crich/needle kit if particularly paranoid. If you're building a kit to go out into the wilderness or such then you start adding in sutures, antibiotics, splints, etc. The goal is to have things that would otherwise be too temporally distanct to administer effectively not to become a walking ED...

/end opinion

 

[medic25]

When I had my first daughter I put a laryngoscope and some Magill forceps in the diaper bag. I figure 99% of the emergencies can wait until EMS arrives or I get to the ED, but I want the ability to retrieve any airway obstructions in a hurry if the need arises.

 

[Arcan57]

Agree on dermabond (vet grade stuff is pretty cheap on amazon and is more flexible than superglue which tends to be brittle). Gave thought to intubating equipment but decided not to pull the trigger. Have had to clear airway obstructions twice and both times flipping kid upside down and back blows worked in seconds.

 

[RoadNurse33]

you need interventions that need to be initiated before even the paramedics get there. I can't think of many diseases that qualify especially in kids. Anaphylaxis, dysrhythmia, tension pneumothorax, massive hemorrhage, asthma. So EpiPen, tourniquet, 16g needle, and albuterol MDI.

DeadCactus nailed it.

Massive hemorrhage-3 mins. MET III Tourniquet, Celox gauze+H bandage (or Israeli bandage)

Airway-6 mins. A set of NPAs.

Tension pneumo-15 mins. 16 gauge x 2 for peds, 12 gauge x 2 for adults. Don't make the mistake of grabbing a 14 gauge from the IV cart. It's too short.

Sucking Chest Wound: Halo chest seals. Not ascherman.

Cric kit: scalpel, bougie, tube. You put a tube in...you're gonna need a BVM. Sounds like "if you give a mouse a cookie" to me. Needle cric in kids is a bad day...

If you get a BVM, get a peds bag (plenty of tidal volume for an adult) and get a neo/child/adult mask.

EpiPen and Albuterol MDI.

If you really want a Laryngoscope... a Mac 4, Miller 2, Miller 0 and a pair of Magill's.

EDIT** I forgot two items and one suggestion:
1)Headlamp. Some basic one from REI, nothing fancy.
2)Turning someone on their side is pretty effective at managing secretions but it has its limitations. There really is no substitute for suction. The manual hand pump powered ones are a joke. I've been using the Laerdal LCSU 4 with the 300mL reservoir for the past year and I love that thing. It is $500 though...you're better off purchasing the above mentioned items first.

Finally, the suggestion: make sure that your house numbers can be clearly read from the street, both day and night. First thing I would do when I turned onto the street of the dispatched address was look in three locations for numerics: 1)under the porch light 2)on the mailbox and 3)painted on the curb. First house: I checked under the porch light, second house the mailbox, third house the curb. If you have your house numbers in all three of those locations, they won't drive by your house. It happens. Everyone does it. And it sucks.

 

[TooMuchResearch]

Who are pgy-1s getting to write for the meds?

 

[Birdstrike]

Don't forget the Disney Princess and Spider-Man band-aids. These will be used 100 to 1 more often than the above items and will raise your parental Press-Ganey scores dramatically. None of those home-cric kits or your improvised McGyver ECMO machine will impress your kids one lick.

Busting out with the old-school brown band-aids = parental fail. Unacceptable.

For extra credit: rubber gloves that once blown up and have two eyes drawn on them look exactly like a chicken, and are good for 20 minutes of mindless fun (if you're less than 10).

 

[Birdstrike]

Be glad you're not my kids. I don't have any of this stuff at home, so I guess my cric kit is a butterknife and plastic curly straw.

I will admit I have wondered if it is poor parenting not to have a kit at home....

I don't have this stuff, either. Just the Princess and Spider-Man Bandaids and gloves that when blown up look like chickens. Parental-Press Ganey = 5/5

 

[Siggy]

Go big or go home...
https://www.zombiehunters.org/forum/viewtopic.php?f=43&t=33826
https://www.zombiehunters.org/forum/viewtopic.php?f=43&t=33826

 

[Birdstrike]

Go big or go home...
https://www.zombiehunters.org/forum/viewtopic.php?f=43&t=33826
https://www.zombiehunters.org/forum/viewtopic.php?f=43&t=33826

When you're dressing sucking chest wounds, doing escharotomies and needle cric-ing your kids and needing a kit like that, I say, "Dude, maybe let's just try some basic parenting and prevention."


Kid: "Mom! Will you tell Dad to stop, please? He's needling my chest again...."

Mom: "Yes, Susie, and 'good manners' using the magic word 'please,' honey."

Lol.

But seriously, if I can't fix it with a Heimlich maneuver, Princess Bandaid, a can of "walk-it-off" spray, or hug, I'm calling 911 and asking you to fix it for me.

J---s, people.

 

[Pons Asinorum]

Would benefit from some editing for home use, but there was a recent EMCrit podcast with Keith Conover devoted to SAR/home/personal carry kits with some good printed references. Dr. Conover's personal web page is pretty informative as well.

www.conovers.org

 

[Birdstrike]

Screw it. I'm just converting one of the kid's bedrooms into an ICU room complete with ventilator, code cart, EVD pressure monitor, and most importantly hot ICU nurse. Har har.

Might be helpful if grandma bites it while visiting.

 

[Rendar5]

What is happening at your home that your kids are at risk for a sucking chest wound, tension pneumo, or massive hemorrhage or god forbid need a Crich. If they are cut bad enough to need stitches take them to the er or run to work and steal some supplies. If they choke, do the Heinrich. If they drown or get struck by lightning do mouth to mouth. If they hurt themselves enough to need a splint, go to the er or steal some supplies. If they are at risk for sudden cardiac days rhythmic while running around your house, sure buy a portable aed. But most kids are not.

As above stock bacitracin, band aids, medical tape, gauze, and keep Benadryl and Motrin around the house. Anything else go to the drug store for or take them to the er if it's an emergency. If your kids have allergies keep albuterol and an epipen around too. That's it

 

[RoadNurse33]

What is happening at your home that your kids are at risk for a sucking chest wound, tension pneumo, or massive hemorrhage or god forbid need a Crich.

Oh I agree completely with this sentiment. Benadryl, motrin, zofran ODT, and bandaids are all you need. The most important comment from @DeadCactus was that someone else needs to be treating them...

I do think every Harry Homeowner that does any kind of work with a power saw should have a tourniquet though. I know, I know...chlorine in the gene pool.

 

[Birdstrike]

Oh I agree completely with this sentiment. Benadryl, motrin, zofran ODT, and bandaids are all you need. The most important comment from @DeadCactus was that someone else needs to be treating them...

I do think every Harry Homeowner that does any kind of work with a power saw should have a tourniquet though. I know, I know...chlorine in the gene pool.

I must confess, I do also keep some amoxicillin around, and some steroids, which saves the 3am Rx call in, when my kid has a croup attack. Also, zofran for the pukes. Not treating vomiting plays great until you're the one cleaning the carpet at 3:00 am. Come to think of it, I have a virtual pharmacy stored up over the years, including eye drops, bactrim, cortisporin, and Tylenol/Motrin. Also have some flagyl my dog needed once. Basically any infectious disease I can treat in my own kitchen.

Treating my own kids. I know. Naughty.

 

[DeadCactus]

when my kid has a coup attack

I hate coup attacks. I've found poison gas to be a more effective treatment though. A widespread program of systematic torture is really the way to go though, you know the whole ounce of prevention thing...

 

[Birdstrike]

I hate coup attacks. I've found poison gas to be a more effective treatment though. A widespread program of systematic torture is really the way to go though, you know the whole ounce of prevention thing...

If you hate coup, try contra-coup. Then you'll really know fear.

 

[Perrin]

Wow, we've got some paranoid parents.

That's going to be one hell of a backpack you have to haul around. All of this is going to sit in a closet gathering dust. The meds will have expired. The bandaid box will be gone, cause you'll just keep some in the car and the bathroom. What if you are at work? Are you going to talk your spouse or older child through a cric or needle decompression? The last needle I did on a kid, the mom, driver, was still stuck in the car and being cut out by the FD.

I agree if your child has a condition that keeping meds available at home is prudent, but preparing for every potential situation is absurd. I'd rather have an ounce of prevention.

No riding 4-wheelers without a helmet, adult supervision, a training course, and never at night. We've all seen this scenario play out. Medications kept high and out of reach, though it's always at grandma's house where they get into the digoxin.

But, if we're going for the ultimate preparedness, know the lat and long coordinates for your house if you live out in the sticks and need air-evac. C-collar if Timmy falls off a horse or 4-wheeler. Heck, maybe even a smoke grenade to pop if you're out in the woods camping/fishing and need to signal your location.

 

[Birdstrike]

CremasterFlash, you jinxed me! Just as I was finishing up my response to the thread started by the guy that says he hates EM and just quit it forever and couldn't be happier, I heard from my kids' room, "I just threw up.....I just threw up...."

Ran upstairs and chocolate-ice-cream-chicken-kabob-sweat-potatoes-orange-juice vomit SPRAYED everywhere! Now, after 30 minutes of nose plugging, gagging-vomit-carpet-bead-sheet cleaning, guess what I did?

Busted out the Zofran ODT kid-medicine pharmacy-stash, survival kit. 1/3 of a Zofran 8mg ODT down the hatch, little girl.

Yoo-hoo!

Add carpet cleaner, air freshener, and vomit bucket to that kid-survival kit.

(Did not make up one letter of this post, unfortunately.)

 

[RoadNurse33]

Heck, maybe even a smoke grenade to pop if you're out in the woods camping/fishing and need to signal your location.

Popping green smoke cancels the air strike...laser pen is your best bet to signal location.

 

[medic25]

Don't forget the Disney Princess and Spider-Man band-aids. These will be used 100 to 1 more often than the above items and will raise your parental Press-Ganey scores dramatically. None of those home-cric kits or your improvised McGyver ECMO machine will impress your kids one lick.

Busting out with the old-school brown band-aids = parental fail. Unacceptable.

The problem with being liberal with your Disney Princess band-aids is it encourages the band-aid seeking kids. I can go through a box a week when the little seekers have an outbreak of imaginary boo-boo's. My daughter is allergic to brown band-aids, gauze pads, and steri-strips. The only thing that works is that thing that starts with a D..... Disney something....

 

[Birdstrike]

The problem with being liberal with your Disney Princess band-aids is it encourages the band-aid seeking kids. I can go through a box a week when the little seekers have an outbreak of imaginary boo-boo's. My daughter is allergic to brown band-aids, gauze pads, and steri-strips. The only thing that works is that thing that starts with a D..... Disney something....

Your kids are seeking already? Geez...kids these days. You've got a long road ahead of you, dog. This is how they start. Today, inappropriate bandaid use, tomorrow, demanding Dilau-lau for a wiggly baby tooth. Maybe you should put some bandaid-narcan in your kit, or start some Princess band-aid detox, STAT.

 

[gutonc]

Your kids are seeking already? Geez...kids these days. You've got a long road ahead of you, dog. This is how they start. Today, inappropriate bandaid use, tomorrow, demanding Dilau-lau for a wiggly baby tooth. Maybe you should put some bandaid-narcan in your kit, or start some Princess band-aid detox, STAT.

We've recently started a Teenage Mutant Ninja Turtles bandaid maintenance program to try to get the 7 year old off the princess sauce. We still do PRN princess band aids for real boo boos but there's a 30 band aid limit each month.

She's kicking the habit, but it's a slow painful process. I'm worried about a pretty brutal relapse when she discovers the Frozen band aids.

 

[Birdstrike]

Kid woke up with croupy cough today. Steroids given. lol. Score!

Not even joking. Lol

Kids....unbelievable petri dishes. lol

 

[Daiphon]

EMLA + Tegaderm + 27g = essential for splinters... at least the first two; preferred sharp pointy instrument at your discretion.

Cheers!
-d