ArticleAEM education and training2025
Epinephrine Dosing by Emergency Medicine Residents During a Simulated Prehospital Pediatric Cardiac Arrest.
Article in AEM education and training, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
1 citing paper in PubMed.
- Epinephrine Dosing by Emergency Medicine Residents During a Simulated Prehospital Pediatric Cardiac Arrest.AEM education and training · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Pediatric prehospital dosing errors occur at high rates, up to 60% for epinephrine. Senior emergency medicine residents (EMR) in the Western Michigan University Homer Stryker MD School of Medicine (WMed) residency respond as EMS physicians to cardiac arrests in Kalamazoo County. We sought to determine error rates for weight estimation, epinephrine doses, dose administration mechanics, and esophageal intubation (EI) recognition by EMRs at the end of the PGY-1 year, during EMS physician training summative testing. Methods: Sixteen PGY-1 EMRs were observed during a simulation: 5-year-old with an EMS EI in asystole requiring multiple epinephrine administrations by the EMR. All EMRs had completed Pediatric Advanced Life Support (PALS). Two observers scored performance. Scenarios were recorded. Recordings and scores were reviewed and discussed by observers. Any disagreements were resolved by consensus. Dosing error was defined as > 20% difference from the correct dose. Results: All EMRs obtained correct weight with 15 (94%; 72.0%, 99.0%) using length-based tape (LBT) and one (6%) guessing. Four near-miss errors occurred with the LBT. Four (25%) and two (12.5%) of the first and second epinephrine doses, respectively, were incorrect. Five (50%) errors occurred using graduations on the preloaded syringe, and five (50%) were due to air bubbles in the administration syringe. There were no ten-fold errors. Three (19%) EMRs took 3 attempts to assemble the preloaded syringe, six (38%) did not screw the preloaded syringe together correctly, seven (44%) had difficulty attaching a stopcock to the preloaded syringe, and 14 (88%) did not prime the stopcock. One (6%) failed to recognize EI. Conclusions: PALS-certified PGY-1 EMRs, accurately estimated patient weight, had a high rate of epinephrine dosing errors and frequent difficulty assembling preloaded syringes. To address these errors, training will be developed that includes a checklist, LBT use, weight determination hierarchy, assembling epinephrine preloaded syringes, techniques for appropriate dose administration, and recognition of EI.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.