Last post, Carol provided a detailed question for a manuscript in progress about giving Benadryl to a 2y/o boy who some nasty kidnappers have taken. They want the child to be quiet. The child is rescued by the police and taken to the ER. What is treatment in the ER for this fiction scenario? Check last Wednesday’s post for her full question.
Benadryl can be a tricky drug, particularly in the pediatric population. I am a pediatric ER nurse and have seen lots of kids get Benadryl and get too much Benadryl. The issue is this... an appropriate dose may make them sleepy but not knock them out. A child in a high stress situation may not get sleepy because his adrenaline may counteract the effects of the Benadryl. If you give more than the appropriate dose of Benadryl, they can actually begin to have toxic effects and are not very sleepy at all. In fact, they can be more like little Tasmanian devils.
I think a better choice for your fiction scenario might be a sleeping pill or tranquilizer. Something your nefarious characters may have around via prescription. Now, I’m going to defer publishing a drug and appropriate dosing here as you can find that yourself by Googling “tranquilizer dosing in kids/pediatrics” and it will give you several drug names. From those drug names you can Google the drug by typing “(drug) dosing in pediatrics). The pill could be crushed and given in something like a spoon full of pudding. A tranquilizer will have a more predictable effect than Benadryl. I think the EMS response is reasonable considering his vital signs.
In the ER, we're going to assume worst case scenario. If he was kidnapped (I'm assuming he has been given that the cops rescue him), we're going to assume the kidnappers may have given him other bad things. Standard treatment for drug ingestion is to draw blood for salicylic acid (Aspirin) and acetaminophen (Tylenol) levels. Probably baseline labs are in order to check his blood electrolytes.
We'll want his urine for a urine drug screen. This will check for common drugs of abuse and also prove that he was given a tranquilizer if the kidnappers aren't forthright with what they did give him. If we know the child received the drug within 60 minutes of his arrival to the ED, the physician may choose to give activated charcoal, which is a substance given orally to help absorb the drug from the stomach. He'll be placed on a monitor and observed for several hours until the drug wears off and he’s back to his normal baseline.
Hospital admission is unlikely as long as he does well during his ER observation period and we feel he’ll be in safe hands with the mother. We'll take a good look over his skin... checking for unusual bruising that may indicate he'd been abused/injured.
The circumstances of the child's kidnapping are unclear. We would contact the police but it is clear that the police are involved in your scenario. This is a situation where we will also involve social work as well either for support of the mother, over concern for the child if we felt a parent's negligence was a factor in the kidnapping, or family dynamics were concerning… say there’s an acrimonious divorce and the mother states the father was involved in the kidnapping. These factors could increase conflict in your story.
What other factors can increase conflict in Carol’s story?
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