Cognitive Aid Solutions for Use During a Pediatric Crisis

Educational Objectives

The goal of this program is to improve patient outcomes through use of cognitive aids in pediatric emergencies. After hearing and assimilating this program, the clinician will be better able to:

1. Compare the Pedi Crisis 2.0 app with SafeLocal.
2. Explain the strengths of the Pedi Stat app in pediatric emergencies.

Summary

Utility of cognitive aids: some important steps can be overlooked in high-stress situations, suggesting the value of cognitive aids; data supports the use of cognitive aids; decision support technology minimizes unnecessary steps, particularly in critical events; it improves the completion of tasks critical to success compared with memory alone; pre-induction checklists demonstrated improved performance in residents in simulated interactions; standardization improves care, decreases errors, improves the quality and efficiency of care, improves patient satisfaction, and facilitates better coordination among teams

Pedi Crisis 2.0 app: an app version of the critical events checklists put together by the Society for Pediatric Anesthesia (SPA); it suggests specific steps be followed during critical scenarios; one tab is for verification of diagnosis, including patient presentation and common causative agents (eg, latex, neuromuscular blockers, contrast, antibiotics); it also assists in differential diagnosis, eg, the condition may be bronchospasm, embolism, or sepsis rather than anaphylaxis; it suggests possible treatment options, eg, turning up the fraction of inspired oxygen to 100% or removing the causative agent; it also informs about medications and doses (based on the patient’s weight); it also allows clinicians to notify another team or surgeon for help, eg, performing a transesophageal echocardiography or initiate compression; there is also a link that takes clinicians to a cardiac arrest algorithm; includes extracorporeal membrane oxygenation (ECMO), which clinicians should consider in pediatric cardiac arrest; it is a completely free resource; there are 29 different emergencies

SPA Case Guides: provide a brief summary of diseases that require surgery; indicates the significant anesthetic implications for each case and allows the anesthesiologists to review and grasp key things required for the case; provides background considerations and may include a link to more information about the disease; provides a bullet point list for things required for preoperative workup, setting the room (drugs, infusion, special monitoring, ECMO), intraoperative considerations (alteration in blood pressure, neuromonitoring, possible blood loss), and case-specific complications; this resource requires SPA membership and is free for trainees

OrphanAnesthesia: not 100% specific to pediatrics; covers orphan or rare diseases; provides peer-reviewed anesthetic recommendations on orphan diseases; includes the disease summary, common cases for disease-associated surgery, types of anesthesia (eg, volatile, nonvolatile), additional workups required (eg, echocardiography), laboratory tests required, anticoagulation considerations, positioning considerations (eg, predisposition to fractures), interactions with common medications, recommended anesthetic procedures, types of monitoring, possible complications, postoperative care and monitoring, and ambulatory anesthesia recommendations

OpenAnesthesia: a free online resource that offers peer-reviewed educational content on a multitude of topics; includes podcasts, pathologies, and descriptions; useful for a brief refresher on a particular topic; has libraries of >1300 keywords and >120 videos

SafeLocal: provides information related to safe dosing of local anesthetics, including mixing different anesthetics; allows entering the patient weight; also provides information regarding the volume left over for anesthesia and for the surgeon; free for use

Pedi STAT: good for clinicians who do not provide consultation to pediatric patients routinely; provides information related to dosing, tube size, and has great trauma applications; provides complete information based on weight, age, or height; the information provided by Pedi STAT includes normal vital signs and parameters, recommended sizes of airway and emergency equipment, and doses of medications; this is not a free app and requires a one-time payment of $5; the information also includes seizure medication doses, management of hypoglycemia, use of specific dextrose concentrations, procedural sedation doses including doses of single dose medications, induction medications, pain medications, the management of allergies and anaphylaxis, and other measures required during emergencies

SPA One-Pagers: provide clear and concise information about a given topic; easy to read and typically have detailed references for supporting the data; cover a variety of topics (eg, medical education, faculty development, sustainability, wellness); published by SPA; free for use

Readings

Clebone A, Burian BK, Watkins SC, et al. The development and implementation of cognitive aids for critical events in pediatric anesthesia: The Society for Pediatric Anesthesia Critical Events Checklists. Anesth Analg. 2017;124(3):900-907. doi:10.1213/ANE.0000000000001746; Clebone A, Strupp KM, Whitney G, et al. Development and usability testing of the society for pediatric anesthesia pedi crisis mobile application. Anesth Analg. 2019;129(6):1635-1644. doi:10.1213/ANE.0000000000003935; Marshall S. The use of cognitive aids during emergencies in anesthesia: a review of the literature. Anesth Analg. 2013;117(5):1162-1171. doi:10.1213/ANE.0b013e31829c397b.

Disclosures

For this program, members of the faculty and planning committee reported nothing relevant to disclose. Dr. Sisk’s lecture presents information related to the off-label or investigational use of a therapy, product, or device.

Acknowledgements

Dr. Sisk was recorded at the Carolina Refresher Course 2023: 34th Annual Update in Anesthesiology, Pain, and Critical Care Medicine, held June 18-22, 2023, on Kiawah Island, SC, and presented by the University of North Carolina at Chapel Hill, School of Medicine. For information on future CME activities from this presenter, please visit https://www.med.unc.edu/cpd. Audio Digest thanks the speakers and presenters for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0.75 CE contact hours.

Lecture ID:

AN661701

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.