For a primary care physician, sick patients come with the territory, but critically ill children can rattle even the most assured physician. Whether it is a sick child in a clinic setting or a code on the peds floor, you have to be ready to intervene decisively. For beginning interns to seasoned family physicians, a quick reference to age based dosing of meds and equipment is a must.
I recently reviewed Paediatric Emergencies, an excellent emergency peds reference for UK providers. In that review I stated how Pedi STAT is my go to choice for a pediatric emergency app. Here at iMedicalApps we have reviewed Pedi STAT previously. Over the years, alternatives to Pedi STAT have been released, including PalmPedi, BluCard and Pedi Crisis. This review will take a look at the Emergency Medicine Resident Association’s (EMRA) Peds Meds app — aimed at Emergency Medicine, family medicine, and pediatrics health providers.
EMRA is one of the most prolific resident groups with an outstanding website and a history of making numerous medical apps that are just as useful for EM attendings and primary care providers as they are for EM residents. Here on iMedicalApps we have reviewed a number of their medical apps, including their Antibiotic Guide, Basics of EM, PressorDex, and Peds Airway.
You are working at a rural ER when a mother rushes in with her 5 year old son who she says has been wheezing uncontrollably since coming home from a friend’s house. Over the last hour he has been gasping more and has urticaria all over his body. The nurse tells you he is pale, tachypneic, tachycardic and hypotensive for his age. You immediately begin treating the patient for anaphylaxis and prepare your team to treat anaphylactic shock and secure his airway. Many seasoned pediatric ER doctors would likely be able to handle this without batting an eye, but what about in a primary care clinic? A resident on call? The EMRA Peds App is ideal in these situations.
When you first open the Peds Meds app, it immediately asks you for the patient’s weight or an estimated weight based on age. It also allows you to scroll your finger along the side to set the weight even more rapidly. Unlike PediSTAT, you do not have the choice of entering the patient’s length or Broselow color.
Regardless of the method of data entry, it can be accomplished almost instantly.
Once you enter the patient’s weight, you have the choice of selecting Meds, Useful Calculations or PALS icons along the bottom of the app. I somewhat prefer PediSTAT’s user interface that immediately opens the app to a list of categories, but I also like the fact I can instantly get to PALS algorithms in the Peds Meds app. I think each method has its pros/cons and may just be personal preference and time of use to determine which is “better”. The biggest difference is less the interface itself but the emphasis on “meds” in Peds Meds rather than specific scenarios as in PediSTAT. Selecting Meds, brings up a list of medication categories ranging from Analgesia to Seizure. The list initially looks incomplete until you realize that more information is listed under Useful Calculations.
For our patient, we select “Anaphylaxis” which brings up weight based dosing for epinephrine, antihistamines and steroids. Unlike PediSTAT there isn’t much of an “algorithm” to follow, but rather the treatment is implied based on the order of the meds. Also there isn’t any supporting evidence listed in the different sections for the materials for the recommended medications in the app. It would also be ideal to see fluid recommendations from within the anaphylaxis section, but not even PediSTAT gives that information under the individual sections. Both apps are easy to navigate from one section to another so you can quickly jump to get fluid recommendations.
Despite our efforts of using the anaphylaxis algorithm, our patient continues to worsen prompting intubation. Clicking on Useful Calculations opens the section of the app which displays age/weight appropriate endotracheal tube information but you still need to go back to the Meds section to get RSI medication dosing. Again, this is super quick, but still seems a bit cumbersome compared to the EMRA Peds Airway app or PediSTAT. One thing I do like about each section is the clarity of the icons for each category and easy to read text. Furthermore, tapping on some of the subsections opens up all of the ET tube sizes for all ages in the app just in case you make an error when first entering data in the app. It also gives the formulas behind some of the calculations.