STARS Train the Trainer Class (TtT) - Beta-Balancing Act with Instructor Notes

Balancing Act with Instructor Notes

Pdf Summary

This lecture introduces EMS considerations for Children with Medical Complexity (CMC), emphasizing that although CMC patients represent only ~1–1.5% of pediatrics, they account for a disproportionate share of EMS and emergency resources. It highlights a mismatch between field expectations and training, noting many providers have had little formal education on key skills such as emergency tracheostomy care. The lecture encourages pre-planning: EMS and families should meet before emergencies to understand the child’s baseline status, equipment, transport needs, and any care plans or advanced directives.<br /><br />Key pitfalls include misinterpreting abnormal-but-baseline findings, overreliance on caregivers (who may be absent), not following specialty letters, and failing to administer time-sensitive home emergency medications (e.g., steroids or clotting factor). Assessment guidance stresses establishing baseline appearance and function, recognizing syndromic features and technology dependence (oxygen, cardiac scars, g-tubes, trachs, ventilators, LVADs).<br /><br />A major section covers tracheostomy emergencies: treat the trach like an endotracheal tube, prioritize patency/placement, suction and oxygenate, bag through the trach, and perform an emergency trach change when needed (“when in doubt, change it out”). Home ventilator transport tips include adding oxygen via inlet if available, never transporting with humidifier water in-line, securing the vent, and bringing backup batteries/cords; switch to BVM readily if alarms persist.<br /><br />Other device-focused topics include VP shunts (high suspicion for failure with vomiting, lethargy, irritability, seizures—urgent transport) and intrathecal baclofen pumps (withdrawal can be fatal; treat with high-dose benzodiazepines until baclofen is restored).<br /><br />Three scenarios illustrate common CMC emergencies: adrenal crisis mimicking septic shock (treat with steroids), seizure management in a ventilated child on a ketogenic diet (treat seizures; correct hypoglycemia cautiously to preserve ketosis), and congenital heart disease with baseline low oxygen saturations where dehydration/illness may trigger right-sided heart failure (calm the child, cautious fluids, titrate oxygen to baseline). The lecture concludes that improving care requires listening, staying calm, involving caregivers, accurately defining baseline, and frequent ongoing training.

Keywords

Children with Medical Complexity (CMC)

pediatric EMS

pre-planning with families

baseline assessment pitfalls

tracheostomy emergency management

emergency trach change

home ventilator transport

VP shunt malfunction

intrathecal baclofen pump withdrawal

adrenal crisis and stress-dose steroids