Special Populations (Obstetrics, Pediatrics, Geriatrics, Bariatrics)
Special populations require adjusted assessment and dosing: obstetric, pediatric, geriatric, and bariatric patients differ in physiology, anatomy, and communication.
Core rules
- Obstetrics: in late pregnancy, displace the uterus leftward to reduce supine hypotension. For eclamptic seizures, give magnesium sulfate per protocol and protect the airway. For postpartum hemorrhage, perform fundal massage and give oxytocin per protocol.
- Pediatrics: use the pediatric assessment triangle (appearance, work of breathing, circulation). Weight-based dosing is mandatory; epinephrine for anaphylaxis is 0.01 mg/kg IM (max 0.5 mg). Use length-based tapes or a calculated weight.
- Geriatrics: atypical presentations are common-ACS may present as dyspnea or confusion. Review polypharmacy and anticoagulants.
- Bariatrics: anticipate difficult airway and ventilation; use appropriate equipment, ramped positioning, and adequate manpower for lifting.
Worked example
A 36-week pregnant woman has a seizure. You place her in left lateral tilt, protect her airway, give oxygen, and check glucose. Per protocol, you give magnesium sulfate. You avoid supine positioning and transport to an obstetric facility.
Traps
Keeping a pregnant patient flat; giving adult epinephrine doses to a child; attributing geriatric confusion to age; and underestimating bariatric equipment needs.