Wednesday, April 13, 2011

Medical Question: Carol's Answer

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?


Carol Moncado lives with her husband in Southwest Missouri. When she isn’t writing Inspirational Romance or Romantic Suspense, she’s teaching American Government at a community college, hanging out with her four kids, reading, or watching NCIS. You can find her at:, , and her newest blog, Pentalk Community Blog, where she serves as editor-in-chief: .


  1. Hi, Carol,

    Along with LEOS (law enforcement officers), EMS would be dispatched to the scene. When I read your scene scenario (although I know you simply described the story skeleton to us), my thinking was that the on-scene EMS crew seemed non-existent and acted only as a taxi cab, which isn’t realistic (but I’m guessing it’s not like that at all in the manuscript).

    You're correct: we wouldn't go L&S (lights and sirens) to the hospital on this Call – from the way you described it, this probably is an alpha Call (the least serious). However, we always go L&S enroute to a Call.

    If you want me to go into detail on how EMS would handle this Call, let me know. I'll touch on the basics to give you a general idea – we’d insert a line (IV) and push meds. We'd place him on the LifePak (heart monitor) and review the EKG results to verify the drug won't cause him to code. Since the boy’s SATs (O2 levels) are within normal range and he’s clearly not hypoxic, we’d administer oxygen via a nasal cannula at 2L and only if the boy would tolerate it; if not, we’d ditch the NC unless his respiratory system started to struggle. The boy is conscious and alert, right? Jordyn smartly discussed activated charcoal. To reverse the actions of an orally given drug via the kidnappers, we’d administer activated charcoal to soak up the med in the stomach before it’s absorbed into the bloodstream. The way you described the situation, the only concerning S&S (signs and symptoms) at this point is the boy’s heart rate, and it seems like it’s within normal range, just on the low side, so he’s very stable.

    The ED (emergency department) would continue with follow-up care of the little boy once we transfer medical care to them, although to be honest, with your scenario much of the medical care would be done via EMS. It's amazing the things EMS can do in the field, minor heart surgeries included. Often times, it’s unnecessary for us to transfer a patient to the ED because we’re able to rectify the emergency situation and all our medical interventions have stabilized the patient to the point they either refuse to be taken to a hospital or it’s simply not necessary.

    I’m thinking like a writer here – as for the drug given to the boy, I think an illegal opiate of some sort would be good for your story. It would be believable (and I think exciting) since a criminal could easily have it on-hand and know the accurate doses and routes to use to best suit his/her evil needs. An opiate is a depressant, perfect for your story. The EMS crew would administer IV narcan at the scene to reverse the effects from that drug. With our scene size-up, we can quickly and easily figure out what drug was given, so just input that into your story and you’ll be set.

    Good luck with your story -- it sounds exciting!!!


  2. Dianna,

    Thanks so much for the EMS perspective.

  3. Jordyn, thanks for the detailed answer to Carol's question. I was curious, after I just read your previous post, what the answer was. Her WIP sounds interesting!

    DiAnn, I enjoyed reading the senerio from an EMS's prespective!

    ~ Katy

  4. Katy,

    Always great to have you stop by! Hope you are well.