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Broselow tape
The Broselow Tape, also called the Broselow pediatric emergency tape, is a color-coded length-based tape measure that is used throughout the world for pediatric emergencies. The Broselow Tape relates a child's height as measured by the tape to their weight to provide medical instructions including medication dosages, the size of the equipment that should be used, and the level of energy when using a defibrillator. Particular to children is the need to calculate all these therapies for each child individually. In an emergency, the time required to do this detracts from valuable time needed to evaluate, initiate, and monitor patient treatment. The Broselow Tape is designed for children up to approximately 12 years of age who have a maximum weight of roughly 36 kg (79 lb). The Broselow Tape is recognized in most medical textbooks and publications as a standard for the emergency treatment of children.
To use the Broselow Tape effectively, the child must be lying down. Use one hand to hold the red end of the tape, so it is even with the child's head. (Remember: "red to head"). While maintaining one hand on the red portion at the top of the child's head, use your free hand to run the tape down the length of the child's body until it is even with their heels (not toes). The tape that is level with the child's heels will provide their approximate weight in kilograms and their color zone.[citation needed]
As the tape is not completely accurate, care is required with its use.
The Broselow Tape is based on the relationship between weight and length; each color zone estimates the 50th percentile weight for length, which for practical purposes estimates the ideal body weight (IBW) for emergency dosing. Because of the recent obesity epidemic, concerns have been raised as to the accuracy of the tape to determine acceptable weights and subsequently acceptable doses of emergency medications.[citation needed]
The most recent version of the Broselow Tape incorporates updated length/weight zones based on the most current National Health and Nutrition Examination Survey data set.[citation needed] Utilizing this data set to examine Broselow Tape predictions of actual body weight with the revised zones reveals that approximately 65% of the time the patient's measured length places them in the correct zone for actual weight. Of the remaining 35%, ~20% fall into the heavier Broselow-Luten zone above and 13% fall into the lighter zone below, with < 1% outliers falling greater than 1 zone from predicted. If the healthcare provider incorporates a visual estimate of body habitus into the prediction, the accuracy of the estimate of actual patient weight is improved, as confirmed in multiple studies. Specifically, for drug dosing, the patient's length-based dosing zone can be adjusted up one color zone if the child appears overweight. Thus, incorporating a visual estimate of whether the child is overweight provides a simple method to predict actual patient weight that appears to be clinically relevant given the rise in obesity in the U.S.[citation needed]
Although some medications are best dosed by actual body weight (e.g., succinylcholine), most resuscitation medications are distributed in lean body mass (e.g., epinephrine, sodium bicarbonate, calcium, magnesium, etc.) so that IBW as accurately predicted by length, not the actual body weight, would appear preferable for dosing. For most resuscitation medications, the optimal dose is not known, and doses based on IBW or actual weight are likely equally effective.[citation needed]
The PALS guidelines comment on this issue: "There are no data regarding the safety or efficacy of adjusting the doses of resuscitation medications in obese patients. Therefore, regardless of the patient’s habitus, use the actual body weight for calculating initial resuscitation drug doses or use a body length tape with pre-calculated doses."
Studies on the accuracy of predicting endotracheal tube sizes consistently demonstrate the superiority of length predictions over other methods. Unlike medication dosing, body habitus therefore does not affect the accuracy of the prediction.[citation needed]
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Broselow tape AI simulator
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Broselow tape
The Broselow Tape, also called the Broselow pediatric emergency tape, is a color-coded length-based tape measure that is used throughout the world for pediatric emergencies. The Broselow Tape relates a child's height as measured by the tape to their weight to provide medical instructions including medication dosages, the size of the equipment that should be used, and the level of energy when using a defibrillator. Particular to children is the need to calculate all these therapies for each child individually. In an emergency, the time required to do this detracts from valuable time needed to evaluate, initiate, and monitor patient treatment. The Broselow Tape is designed for children up to approximately 12 years of age who have a maximum weight of roughly 36 kg (79 lb). The Broselow Tape is recognized in most medical textbooks and publications as a standard for the emergency treatment of children.
To use the Broselow Tape effectively, the child must be lying down. Use one hand to hold the red end of the tape, so it is even with the child's head. (Remember: "red to head"). While maintaining one hand on the red portion at the top of the child's head, use your free hand to run the tape down the length of the child's body until it is even with their heels (not toes). The tape that is level with the child's heels will provide their approximate weight in kilograms and their color zone.[citation needed]
As the tape is not completely accurate, care is required with its use.
The Broselow Tape is based on the relationship between weight and length; each color zone estimates the 50th percentile weight for length, which for practical purposes estimates the ideal body weight (IBW) for emergency dosing. Because of the recent obesity epidemic, concerns have been raised as to the accuracy of the tape to determine acceptable weights and subsequently acceptable doses of emergency medications.[citation needed]
The most recent version of the Broselow Tape incorporates updated length/weight zones based on the most current National Health and Nutrition Examination Survey data set.[citation needed] Utilizing this data set to examine Broselow Tape predictions of actual body weight with the revised zones reveals that approximately 65% of the time the patient's measured length places them in the correct zone for actual weight. Of the remaining 35%, ~20% fall into the heavier Broselow-Luten zone above and 13% fall into the lighter zone below, with < 1% outliers falling greater than 1 zone from predicted. If the healthcare provider incorporates a visual estimate of body habitus into the prediction, the accuracy of the estimate of actual patient weight is improved, as confirmed in multiple studies. Specifically, for drug dosing, the patient's length-based dosing zone can be adjusted up one color zone if the child appears overweight. Thus, incorporating a visual estimate of whether the child is overweight provides a simple method to predict actual patient weight that appears to be clinically relevant given the rise in obesity in the U.S.[citation needed]
Although some medications are best dosed by actual body weight (e.g., succinylcholine), most resuscitation medications are distributed in lean body mass (e.g., epinephrine, sodium bicarbonate, calcium, magnesium, etc.) so that IBW as accurately predicted by length, not the actual body weight, would appear preferable for dosing. For most resuscitation medications, the optimal dose is not known, and doses based on IBW or actual weight are likely equally effective.[citation needed]
The PALS guidelines comment on this issue: "There are no data regarding the safety or efficacy of adjusting the doses of resuscitation medications in obese patients. Therefore, regardless of the patient’s habitus, use the actual body weight for calculating initial resuscitation drug doses or use a body length tape with pre-calculated doses."
Studies on the accuracy of predicting endotracheal tube sizes consistently demonstrate the superiority of length predictions over other methods. Unlike medication dosing, body habitus therefore does not affect the accuracy of the prediction.[citation needed]