Review of Pedi Crisis app for iPhone & iPad
Codes in Pediatrics are thankfully rare, but that rarity results in less experience when these crisis situations occur. The Society for Pediatric Anesthesia Quality and Safety Committee created checklists to review key management steps in 18 situations they have defined as “critical events” and an iOS app version to go over those steps. While there is a fair bit of overlap between these events and Pediatric Advanced Life Support code situations, the checklists are clearly designed with Pediatric anesthesiologists in mind.
The app, alternatively named “Pediatric Critical Events Checklist” or “Pedi Crisis”, is very simple to use. Users pick from 18 situations, ranging from anaphylaxis to venous air embolism. The app asks users to confirm their selection and then input the patient’s weight in kilograms. Depending on your choice, the app will give you background information (for example, ECG signs of myocardial ischemia) or take you directly to the clinical pathway.
The app includes a clock that begins as soon as the pathway is selected, and is easily called up by pressing the clock button. Depending on the pathway, as time elapses the app will prompt you to check pulses every 2 minutes. The running clock also prevents the phone from going to sleep or into lock mode. Each action is logged and users can call up the log via an icon on the bottom of the screen. Another nice feature is that when choosing medications the app calculates the correct weight-based dose. In a nice QI touch, the prefixes “mili” or “micro” are capitalized to prevent errors.
At the end of the pathway, the app reviews next steps and enables emailing or saving the logs.
The app’s simplicity is a key feature, but there are a couple of frustrating oddities. Steps are split into information and checklist but some steps that have checkboxes next to them are purely informational (such as the steps on how to do effective CPR). The medication calculator function is very helpful but on some checklists you have to click through an extra step to see the calculated dose.
Another minor bug is that while the app has a built in calculator for medication doses, it does not include a calculator for cardioversion, although the app does calculate the joules needed for defibrillation. And while confirmation in crisis situations is essential, the app makes you confirm your selection and your exiting of each checklist, which can be cumbersome (although presumably users will not be cycling through each crisis!). This makes the app more useful in actual code situations but less useful for teaching purposes. Lastly, while the app’s time reminders are useful (e.g., to do pulse checks or switch CPR), having some kind of alert or sound could be an improvement.
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