The ability to manage anesthetic emergencies in pediatric patients is an essential part of a safe anesthetic practice. Many pediatric anesthesiologists are experienced in managing such emergency situations.
The most important risk management of pediatric anesthesia is airway because neonates and infants easily become hypoxic due to their insufficient functional residual capacity, i.e. the volume of air present in the lungs at the end of passive expiration. This is why airway management is the most important not only during induction of anesthesia but also during maintenance of anesthesia and extubation.
Another important risk management is the management of pediatric patients' temperature, including control of room temperature which should also be taken into consideration.
Also, careful attention should be paid not to allow air bubbles in any lines, especially in pediatric patients with congenital heart diseases.
Many of these anesthetic emergencies, however, arise infrequently and individual practitioners experience them personally only a few times within their professional careers.
Due to such rare and unpredictable nature of these emergencies, it can be hard for pediatric anesthesiologists to recall full details of all necessary facts, decision points, and management steps.
Mobile electronic devices such as smartphones and tablets enabled healthcare providers with a quick access to mobile apps that provide useful health-related information across various specialties.
Unfortunately, there are no many apps that deal with the safety and quality of anesthetic care and perioperative management in children.
This was the reason why the Society for Pediatric Anesthesia developed and released a free mobile app, called Pedi Crisis - a quick reference based on a series of critical event checklists that the Society for Pediatric Anesthesia had developed to help clinicians manage pediatric anesthesia emergencies.
The app's main screen enables quick navigation to an alphabetical list of the 26 pediatric emergencies listed in the 'Events' tab, personalized emergency phone numbers, and customizable patient weight.
There are 26 different crises algorithms/checklists in the app, including air embolism, cardiac arrest, difficult airway, hypoxia, trauma, and more.
Each emergency is further broken down into one or more of the following: Dx (diagnosis), DDx (partial differential), Tx (treatment), Drugs (dosage), Misc (miscellaneous), and Crisis for crisis management in case of severe symptoms.
This categorization is consistent for all emergencies within the app. Drugs are listed by dosing per kilogram, or as the calculated dose based on patient weight provided by the user (set in the 'Patient Weight' tab).
This part, however, didn't work for me. I've set different patient weights from 1 kg to 30kg, but there was no change in doses based on the calculation. In other words, drug doses in the 'Drugs' section show general recommendations per kg, and it's up to the provider to calculate the dose for their patients manually. Hence, the 'Patient Weight' section is useless.
Another problem here is the inability to change kilograms into pounds, so the U.S. providers may need a converter for imperial units.
The guidelines for individual emergencies are given in the form of easy-to-follow checklists and algorithms.
The mobile apps have the advantage over the paper algorithms because they allow the users to navigate through the algorithm in an interactive format.
The Pedi Crisis app described its algorithms as interactive, however, this interactive part doesn't work. For example, when calculating treatment (Tx) for the Cardiac Arrest, there are two buttons that users could pick to initiate the algorithm, but none of them worked. Same happened in the differential section for Hypoxia (for the question if the airway cause is suspected).
I haven't tested the iOS version, but it should be noted that interactivity doesn't work in the Android version of the Pedi Crisis app.
Each emergency contains the 'Crisis' section that provides the step-by-step crisis management steps that providers can use to check their preparedness in this type of situation, as well as a facility's resources and policies.
The providers can also add phone numbers for quick access during an emergency in the 'Phone Numbers' tab. The numbers are displayed within the 'Events' section.
At first glance, you might not notice any problems while navigating through the app. Everything is clearly visible and available at your fingertips. Soon, you might notice that navigation is a bit clumsy, especially because the Back button in the app doesn't exist.
Users need to navigate by using either the 'Event' tab to return to the list of conditions or the device's Back arrow that returns them only to the previous page. So if it happened that you'd browsed through several algorithms at once, you might end in a loop which can become frustrating soon.
This perhaps wouldn't be such a problem if there's the ability to shut down the app from the app itself. Unfortunately, to exit the app, users need to do that forcefully.
The algorithms contained within the Pedi Crisis App could help providers, particularly pediatric anesthesiologists glance through the guidelines for individual types of emergencies at the point of care.
The app can also be used as an educational resource for teaching medical students and residents how to handle crisis situations.
There's no doubt that the Pedi Crisis app is a useful resource, however, there's a lot of room for improvement, particularly regarding the UX and UI design.
Benefit: The app was designed for anesthesiologists, certified registered nurse anesthetists (CRNAs), and other members of the pediatric perioperative care team, as well as medical students and residents