By Kevin T. Collopy, BA,
ce article CCEMT-P, NREMT-P,
WEMT, & Greg Friese,
Greg Friese is a featured
speaker at EMS EXPO 2010,
Sept. 27–Oct. 1 at the Dallas
Photo by Eddie Sperling
Convention Center, Dallas, TX.
For more information, visit A primer on pediatric phamacological considerations
CONTINUING As you prepare to leave a community event where you’ve been on standby, a mother hurries
EDUCATION FROM EMS
This CE activity to your tent with her 3-year-old daughter, who has a wheezy cry and is drooling. The mother
is approved by
EMS Magazine, tells you the child is allergic to bee stings and was just stung by three bees. Your partner
accredited by the alerts dispatch for a paramedic squad while you do a quick exam and ﬁnd three sting sites on
Coordinating Board for
the girl’s right arm, hives rapidly spreading across her chest and face, and audible wheezes.
Oxygen is applied and, as you reach for an epinephrine auto-injector, your partner asks if
for 1.5 CEUs. you need the pediatric auto-injector. Looking at the adult auto-injector in your hand, you
• Review anatomical remember that young children like your patient need special doses of medication.
pediatric patients Why does a child need a special dose? from adults’. One of the easiest ways to oxygen, nutrients and other chemicals
that influence drug How is their body different from an understand why drugs may have different into the brain. Because our brain cells
• Discuss pediatric adult’s? Are there other types of patients actions and different effects in children is are very sensitive to harmful substances
pain management who should also be given special consid- to take a system-by-system approach to and cannot be reproduced, it is important
eration? This article discusses special pediatric anatomy. to keep harmful chemicals out of brain
considerations for pediatric drug admin- matter. As a result, the epithelial cells, or
istration. NEUROLOGIC SYSTEM outermost brain cells that connect with
Children’s bodies are a world apart An incredible amount of blood circulates circulating blood at the capillary level,
52 JUNE 2010 EMS www.emsresponder.com
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have grown very tightly together. This Peripheral vasoconstriction occurs earlier adult patient can handle the loss well.
layer of tightly packed epithelial cells, in pediatric patients and is less effective Tachycardia is a common but non-speciﬁc
which is called the blood-brain barrier, at increasing circulating blood volume. response to any increase in the child’s
prevents most proteins and polarized Tachycardia, or rapid pulse rate, needs to metabolic needs, including increased
molecules from entering the brain. While be recognized as a compensation mecha- oxygen demand, cardiac output or energy
lipid-soluble molecules can pass through nism. It is usually OK if it persists until for physical activity.1
the blood-brain barrier easily, most other the underlying problem can be corrected. Seek out the cause of any tachycardia
chemicals are kept out.1 Consider the following case: You’ve to determine what the child is compen-
The protective blood-brain barrier in been called to a country home nearly 25 sating for. A persistently bradycardic
adults is not well developed in children, minutes outside of your normal response heart rate is a serious ﬁnding in children
and is underdeveloped in premature district for a lethargic child. Upon arrival, and is most often triggered by hypox-
infants, as their bodies’ connective you ﬁnd a listless 3-year-old male who is emia.1 Children also compensate with
tissues have not yet been strongly formed. pale and clammy, and pays no attention to tachypnea, or fast breathing.
While the blood-brain barrier normally you as you approach his bed. His mother EMS providers must understand that
keeps potentially harmful drugs and other
toxins from entering the brain, these
same toxins and drugs can easily enter a
tells you Mark has been vomiting and had
diarrhea for four days, and has not eaten
or kept water down since he got sick.
a child’s vital signs (see Table 1) are
quite different from the adult’s. Children