Field Guide: Common Paramedic Medications and Their Uses

Pediatric to Geriatric: Adjusting Paramedic Medications in the Field

Overview

Adjusting medications across age groups is critical in prehospital care. Weight, organ function, physiology, and communication ability change from neonates to older adults and affect dosing, routes, monitoring, and risk of adverse effects.

Key Principles

• Weight-based dosing: Use actual weight when possible; estimate with Broselow tape or length-based tools for children. Neonates and infants require precise calculations.
• Physiologic differences: Children have higher metabolic rates, different fluid compartments, and immature hepatic/renal function; older adults have decreased renal/hepatic clearance, altered body composition, and polypharmacy risks.
• Route and formulation: Use appropriate concentrations/volumes (avoid large-volume injections in small children), consider intraosseous (IO) access when IV is difficult in pediatrics, and prefer oral or subcutaneous routes cautiously in older adults.
• Age-specific monitoring: Continuous respiratory and cardiac monitoring in extremes of age; watch for hypoglycemia in infants and medication interactions in geriatrics.
• Clear communication: Use family for weight/medication history in pediatrics; obtain medication lists and allergy history for older adults.

Common Medication Adjustments by Age Group

• Neonates (0–28 days):

  • Dosing: Strict weight-based mg/kg dosing; minimal rounding.
  • Considerations: Immature liver/kidney function → lower clearance; avoid certain drugs (e.g., some benzodiazepines in prolonged use).
  • Routes: IV/IO preferred for emergencies.

• Infants and Children (1 month–12 years):

  • Dosing: Broselow tape or weight-based calculators.
  • Considerations: Higher metabolic rate → may require relatively higher mg/kg for some drugs; careful with fluid volumes and concentrations.
  • Routes: IM usable for some meds, but IO for critical access.

• Adolescents (13–17 years):

  • Often dosed like adults once above a certain weight (commonly ≥50 kg), but confirm weight and maturity.
  • Consider psychosocial factors and consent issues.

• Adults (18–64 years):

  • Standard adult dosing; adjust for chronic conditions, obesity, or organ dysfunction.
  • Watch for overdose risk and substance use interactions.

• Geriatrics (≥65 years):

  • Dosing: Start low, go slow; reduced renal/hepatic clearance—reduce doses or increase dosing intervals.
  • Considerations: Polypharmacy and increased sensitivity to CNS depressants, anticoagulants; higher risk of orthostatic hypotension.
  • Routes: Avoid high-volume IM injections if frail; monitor for delirium/confusion.

Specific Drug Examples & Adjustments

• Epinephrine (anaphylaxis, cardiac arrest):

  • Pediatric: 0.01 mg/kg IV/IO (1:10,000) for cardiac arrest; IM 0.01 mg/kg (max 0.3–0.5 mg) for anaphylaxis.
  • Adult: Standard adult doses (e.g., 1 mg IV/IO arrest; 0.3–0.5 mg IM anaphylaxis).
  • Elderly: Same emergency doses but monitor for cardiac ischemia and arrhythmias.

• Naloxone:

  • Pediatric: 0.01 mg/kg IV/IM/IN, titrate to respiratory effort to avoid acute withdrawal.
  • Adult: 0.4–2 mg IV/IN, titrate.
  • Elderly: Titrate more cautiously due to comorbidities.

• Aspirin (suspected ACS):

  • Pediatric: Generally avoided for viral illness risk (Reye’s) — aspirin not routinely given to children.
  • Adult: 160–325 mg chewable.
  • Elderly: Same dose unless contraindicated; consider bleeding risk.

• Dextrose (hypoglycemia):

  • Neonates/Infants: Use D10W (diluted) at 5–10 mL/kg (0.5–1 g/kg).
  • Children: D25W (2–4 mL/kg) or D10W depending on IV access and concentrations available.
  • Adults: D50W 25–50 mL IV (12.5–25 g) or D10W infusion for recurrent hypoglycemia; use lower concentrations in elderly to avoid rebound hyperglycemia.

• Benzodiazepines (seizure/agitation):

  • Pediatric: Weight-based dosing (e.g., lorazepam 0.05–0.1 mg/kg IV; midazolam IM/IN 0.1–0.2 mg/kg).
  • Adult: Standard doses (e.g., lorazepam 2 mg IV; midazolam 5–10 mg IM/IN).
  • Elderly: Lower doses; monitor respiratory depression.

Practical Field Tips

• Carry and use dosing aids: Broselow tape, weight-based cards, smartphone calculators.
• Prepare pediatric concentrations to avoid dosing errors (e.g., pre-diluted dextrose).
• Consider IO access early for critically ill children.
• Reassess frequently after medications; observe for under- or overdosing signs.
• Document weight estimate, dose calculation, route, and response.

Quick Reference Table (selected meds)

Final notes

Keep age-appropriate dosing references accessible, practice pediatric calculations regularly, and prioritize safety measures (weight-based dosing aids, double-checks) to reduce medication errors in the field.