Care of Special Populations Across the Lifespan
Children
Weight-based dosing and equipment, age-specific vital signs, and a lower threshold for early escalation. Key patterns: the febrile infant younger than 28 days gets a full sepsis evaluation and admission; PECARN guides head imaging; bronchiolitis is supportive (no routine bronchodilators or steroids); croup responds to dexamethasone; dehydration is judged clinically. Hypotension in a child signals decompensated shock, not an early warning.
Pregnancy
Normal physiology masks deterioration: plasma volume rises, blood pressure falls, heart rate rises, and fibrinogen is elevated, so standard lab cutoffs mislead. Provide left lateral uterine displacement after about 20 weeks, never withhold indicated imaging, treat eclampsia with magnesium sulfate, and remember that preeclampsia before 20 weeks is unlikely.
Older adults
Atypical presentations - delirium, falls, functional decline - are often the only sign of myocardial infarction, sepsis, or a surgical abdomen. Review polypharmacy and potentially inappropriate medications (Beers criteria), screen for fall risk and anticoagulant use, and lower your imaging threshold after trauma.
Other groups
Immunocompromised patients may lack fever or an elevated white count; patients with obesity need weight-based dosing and careful airway planning; patients with disabilities deserve the same standard of assessment with accommodations for communication.
Traps
Applying adult vital-sign thresholds to children; attributing an older adult's confusion to "their baseline"; dismissing abdominal pain in a pregnant patient; failing to adjust drug doses for renal or hepatic function.
Rule of thumb
In every special population the physiology is shifted - interpret vital signs and labs against that population's baseline and escalate earlier rather than later.