Mid-Arm Point in PAEDiatrics (MAPPAED): An effective procedural aid for safe pleural decompression in trauma.

Objective: Life-threatening thoracic trauma requires emergency pleural decompression and thoracostomy and chest drain insertion are core trauma procedures. Reliably determining a safe site for pleural decompression in children can be challenging. We assessed whether the Mid-Arm Point (MAP) technique, a procedural aid proposed for use with injured adults, would also identify a safe site for pleural decompression in children.

Debriefing immediately after intubation in a children's emergency department is feasible and contributes to measurable improvements in patient safety.

Objective: In 2013, our intubations highlighted a safety gap - only 49% achieved first-pass success without hypoxia or hypotension. NAP4 recommended debriefing after intubation, but limited published methods existed. Primary aim is to implement a feasible process for immediate debriefing and feedback for emergency airway management.

A quality improvement initiative to increase the safety of pediatric emergency airway management.

Background: Emergency airway management is commonly associated with life-threatening hypoxia and hypotension which may be preventable.

Aims: The aim of this quality improvement study was to reduce the frequency of intubation-related hypoxia and hypotension.

Methods: This prospective quality improvement study was conducted over 4 years in the Emergency Department of The Royal Children's Hospital, Melbourne, Australia.

Implementation of NAP4 emergency airway management recommendations in a quaternary-level pediatric hospital.

Emergency airway management, particularly outside of the operating room, is associated with a high incidence of life-threatening adverse events. Based on the recommendations of the 4th National Audit Project, we aimed to develop hospital-wide systems changes to improve the safety of emergency airway management. We describe a framework for governance in the form of a hospital airway special interest group.

Planning for disasters involving children in Australia: A practical guide.

Children comprise 19% of the Australian population. Children are at risk of higher morbidity and mortality in disaster events than adults; however, there is a paucity of paediatric-specific disaster preparedness in Australia. Paediatric disaster plans should be developed, tested and renewed regularly.

A randomised controlled trial of cognitive aids for emergency airway equipment preparation in a Paediatric Emergency Department.

Background: Safety of emergency intubation may be improved by standardising equipment preparation; the efficacy of cognitive aids is unknown.

Methods: This randomised controlled trial compared no cognitive aid (control) with the use of a checklist or picture template for emergency airway equipment preparation in the Emergency Department of The Royal Children's Hospital, Melbourne.

Results: Sixty-three participants were recruited, 21 randomised to each group.

Laryngospasm With Apparent Aspiration During Sedation With Nitrous Oxide.

Nitrous oxide and oxygen mixture has become increasingly popular for the procedural sedation and analgesia of children in the emergency department. In general, nitrous oxide is regarded as a very safe agent according to large case series. We report a case of single-agent nitrous oxide sedation of a child, complicated by laryngospasm and radiographically confirmed bilateral upper lobe pulmonary opacities.

Review article: Efficacy and safety of methoxyflurane analgesia in the emergency department and prehospital setting.

This article reviews the evidence for the analgesic efficacy of methoxyflurane in both prehospital and ED settings, as well as the adverse event profile associated with methoxyflurane use. Although there are no published controlled trials of methoxyflurane in sub-anaesthetic doses, available data indicate that it is an efficacious analgesic. There is inadequate evidence regarding its use as an agent for procedural pain.