How do you calculate the correct ETT size for a child in a pediatric resuscitation?
ETT size = (age + 16) / 4
ETT size = (age/4) + 4
ETT size = 4 + 1/4 age
If you find yourself thinking about the order of operations (PEMDAS for anyone who missed elementary school math class) during a pediatric resuscitation, your mental focus is in the wrong place.
Don’t waste mental energy on this! Spend that mental energy on knowing where your Broselow tape and system is and know how to use it. The reality is that pediatric doses and sizes are hard to recall for EM docs who spend the majority of our time caring for adults, and it is even harder to recall under high stress situations which is likely exactly when you need to do so. That’s ok. Rather than spending time and mental energy trying to figure it out or look it up and run the risk of dosing a med incorrectly on a scale of 10s to 100s, just get the Broselow tape!
The Broselow system was invented in the 1980s by an emergency medicine physician named James Broselow. He recognized the need for fast and accurate estimation for the sizes of equipment and doses of meds for pediatric patients in the emergency department. The Broselow system has developed into a tape that can be laid out next to a patient. There is an associated color coding system that provides doctors with the correct sizing and dosing for an ideal body weight correlated to the length of that patient. Sometimes, the supplies are actually included inside a color coded bag. It’s become ubiquitous in emergency departments. You just need to know where it is and how to use it. Check it out during your next peds ED shift.
Even with the current state of childhood obesity, the Broselow tape is still recommended. If you’re concerned about underdosing an obese pediatric patient, you can consider going up one level in your color coding.
Remember adequately and appropriately resuscitated kids are happy kids.
For more on the story behind the Broselow tape’s invention from Dr. Broselow himself, check out this link.
To see the Broselow tape in action, check out this clip from ER.