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34 JANUARY 2018 | EMSWORLD.com SPECIAL FOCUS: PEDIATRICS AND AIRWAY MANAGEMENT the elements is an important consideration. These old-school memory minders pro- vide the most commonly needed critical calculations at your fingertips. And they'll never be rendered inoperable due to a drained battery. The Broselow Tape The original Broselow tape was introduced in 1986 by Drs. Jim Broselow and Robert Luten. If you've been in healthcare for fewer than 30 years, you probably have not known pediatric emergency care with- out the Broselow tape and corresponding Broselow-Luten color zones. Utilized around the world and updated regularly (as recently as June 2017 to include the release of new ILCOR/AHA PALS guide- lines), this system uses an easily recogniz- able measurement format for "color-cod- ing" kids and guiding us through some of the most stressful calculations and "which one?" questions encountered in pediatric emergencies. Key points to remember when utilizing both sides of the Broselow tape: • Always remeasure and confirm the cor- rect color when the child arrives at the ER, just to be safe; • "R&R;": resuscitation and rapid sequence intubation (RSI) on one side, everything else on the other; • "E&E;": epinephrine dose on one side, endotracheal tube size on the other; • Approximate weight listed on the bot- tom of each color zone as determined by length; • Color zones have weight ranges listed from 3–36 kg. The name of the color is printed on the top for color-blind pro- fessionals; • Measure from the head to the heels, not to the toes. When we measure height, we do it from a standing position, not a "tippy-toe" one. If the foot is abnor- mally flexed or extended, the inaccurate measurement could move the child to a different color zone; • And speaking of the head: At one end of the tape is a big red arrow. Red goes toward the head, meaning this is where to start measuring from to determine the child's color and approximate ideal body weight. What about kids who are not at their "ideal" weight?" With the epidemic of obe- sity in children, this is an important consider- ation. But here's the good news: Most of the emergency drugs we give to kids are based on ideal body weight, not actual weight. There are a couple of notable, though now rarely given, exceptions (specifically amio- darone and succinylcholine) that are dosed based on actual weight. So with that in mind, the ideal body weight based on the length (height) of the child is what we are looking for when determining medication amounts. Drugs such as epinephrine, dopamine, mor- phine, fentanyl, and ketamine are dosed based on what the kid should ideally weigh. And the ideal weight rule extends to other administrations as well. The Parkland for- mula for calculating how much fluid a child should receive after a major burn is based on ideal weight, as opposed to actual or estimated weight. But if the kid is obviously huge, the tape has a reminder indicating there may be situ- ations in which you might bump them up a color for medications (but not equipment) if you feel it's appropriate and your protocols or orders allow. What do we mean, not equipment? This is important! Whether they're skinny or fat, the child's airway should be the same size. That's why the child's length is the best pre- dictor of recommended emergency equip- ment (tubes, etc.) size. Just remember, inside Top left: Broselow-Luten color zones and age-weight chart. Top right: the purple color zone for the 2017 Broselow tape. Above: a Broselow color-coded jump bag. (Photos: Armstrong Medical)