Healthcare News - FDA Approves Needle-Free Epinephrine Alternative for Pediatric Anaphylaxis

The U.S. Food and Drug Administration (FDA) has approved Neffy, an epinephrine nasal spray developed by ARS Pharmaceuticals, for the emergency treatment of Type I allergic reactions, including anaphylaxis, in children aged four years and older (33–66 lbs.).

This approval marks the first significant advancement in pediatric epinephrine delivery in over 30 years.

Epinephrine remains the first-line treatment for anaphylaxis, yet research indicates that delays in administration are common due to apprehension regarding needle-based auto-injectors.

Neffy addresses this barrier to potential use by providing a precise, needle-free delivery system that simplifies emergency intervention.

Clinical trials have demonstrated its pharmacokinetic and pharmacodynamic equivalency to traditional epinephrine injections, with minimal side effects.

Designed for stability, Neffy maintains efficacy for 24 months at room temperature and withstands extreme temperatures, ensuring reliability in diverse conditions.

The device is user-friendly, enabling non-medical personnel, such as teachers and caregivers, to administer life-saving treatment effectively.

The nasal spray will be available in the U.S. starting May 2025, with affordability initiatives, including co-pay savings and patient assistance programs, ensuring broader accessibility.

The approval of Neffy reflects a growing shift toward needle-free epinephrine solutions, improving anaphylaxis management and patient outcomes in both pre-hospital and in-hospital settings.

For more information access the Medtigo link.

Further Reading:

ARS Pharmaceuticals (2025) FDA Approval of Neffy® 1 mg (epinephrine nasal spray) for Type I Allergic Reactions, Including Anaphylaxis, in Pediatric Patients Weighing 15 to < 30 Kilograms Accessed March 5, 2024

EMS Hepatic Emergencies - Adults v Pediatric Jaundice

When EMS Providers encounter jaundice in patients, understanding the differences between adult and pediatric cases is essential for accurate assessment and intervention.

1. Etiology of Jaundice:

Adults: Jaundice in adults is often associated with liver disease, such as hepatitis, cirrhosis, or obstruction due to gallstones or tumors. 

Hemolysis (excessive breakdown of red blood cells) or pancreatic issues can also contribute to jaundice.

Pediatrics: In newborns and infants, jaundice is commonly due to physiological immaturity of the liver, resulting in an inability to process bilirubin efficiently. 

This condition is often benign and termed physiologic jaundice. Pathological causes in children can include hemolytic disease, infections, or biliary atresia.

2. Prevalence and Presentation:

Adults: Jaundice in adults is usually less common and more indicative of a potentially severe underlying condition. 

It may present with other signs of systemic illness, such as fever, weight loss, or abdominal pain.

Pediatrics: Jaundice is quite common in neonates, particularly in the first week of life. It may be noticeable in the eyes (scleral icterus) or skin. 

In older children, it is less common and may point to a serious issue.

3. Assessment Differences:

Adults: EMS providers should look for signs of liver dysfunction, such as changes in mental status (e.g., confusion or altered consciousness), abdominal distention, and a history of alcohol use or liver disease. 

Asking about dark urine or pale stools can also help identify underlying liver or biliary issues.

Pediatrics: In infants, checking for jaundice involves examining the skin under natural light. Special attention should be given to whether the jaundice is spreading from the face downward, which indicates increasing bilirubin levels. 

Noting feeding difficulties, lethargy, or poor weight gain is crucial in assessing severity.

4. Immediate Concerns:

Adults: Jaundice in adults often requires further evaluation for signs of liver failure, coagulopathy (e.g., easy bruising or bleeding), or potential sepsis in cases where infection is suspected.

Pediatrics: For neonates, a high bilirubin level (severe hyperbilirubinemia) can be a medical emergency, as it can lead to kernicterus, a type of brain damage. 

Any signs of jaundice persisting beyond two weeks or coupled with symptoms like high-pitched crying or arching of the back should prompt urgent attention.

5. Management Focus:

Adults: Management is often supportive, with emphasis on addressing the underlying condition. Transporting the patient to a facility equipped to diagnose liver issues is key.

Pediatrics: For neonatal jaundice, EMS Providers should ensure the baby is kept warm and hydrated. 

Transport to a pediatric-capable facility is crucial if severe jaundice or any concerning symptoms are noted.

Understanding these distinctions helps EMS Providers make informed decisions and prioritize care when faced with a jaundiced patient, ensuring they tailor their approach according to the patient's age and likely causes.

Further Reading

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey: Wiley Blackwell

EMS Emergencies - Pediatric Patients

EMS providers need to be well-prepared to handle pediatric emergencies as they require specialized knowledge and skills due to the unique needs of children.

Here are some key points they should know:

1. Respiratory Distress: Children commonly present with respiratory distress due to conditions such as asthma, bronchiolitis, or croup. EMS providers should be proficient in assessing respiratory status, administering oxygen, and managing airway obstructions.

2. Febrile Seizures: Febrile seizures are common in young children and are often frightening for caregivers. EMS providers should know how to assess and manage febrile seizures, including ensuring adequate ventilation and preventing injury during the seizure.

3. Trauma: Children are at risk for various types of trauma, including falls, burns, and motor vehicle accidents. EMS providers should be skilled in assessing and managing pediatric trauma, including immobilization techniques and pain management.

4. Sepsis: Sepsis can be challenging to recognize in children, as symptoms may be nonspecific. EMS providers should be vigilant for signs of sepsis, such as fever, tachycardia, and altered mental status, and be prepared to initiate early treatment.

5. Anaphylaxis: Allergic reactions, including anaphylaxis, can occur in children due to food allergies, insect stings, or medications. EMS providers should be trained in recognizing anaphylaxis and administering epinephrine as needed.

6. Dehydration: Children are at increased risk for dehydration due to factors such as vomiting, diarrhea, or fever. EMS providers should be skilled in assessing hydration status and administering fluids as needed, especially in cases of severe dehydration.

7. Seizures: Seizures can occur in children due to various causes, including epilepsy or febrile illnesses. EMS providers should know how to assess and manage seizures, including protecting the child from injury and administering appropriate medications if necessary.

8. Poisoning: Accidental poisoning is a common pediatric emergency. EMS providers should be familiar with common toxins and their effects on children, as well as appropriate decontamination and treatment measures.

9. Cardiac Arrest: While less common in children than in adults, cardiac arrest can still occur due to various causes, including congenital heart defects or respiratory failure. EMS providers should be proficient in pediatric CPR and advanced life support techniques.

10. Communication & Family Support: Effective communication with caregivers is essential in pediatric emergencies. EMS providers should be skilled in providing clear and compassionate communication, as well as offering support to families during stressful situations.

By being knowledgeable about these common pediatric emergencies and having the necessary skills to assess and manage them effectively, EMS providers can play a crucial role in providing optimal care for children in emergency situations.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell

EMS Emergencies - Special Populations (1)

EMS providers should be well-prepared to handle emergencies involving special populations, such as pediatric, geriatric, pregnant, and disabled patients. 

Here are some key considerations for each group:

Pediatric Emergencies:

Children have unique anatomical and physiological differences compared to adults. EMS providers should be familiar with pediatric assessment and treatment protocols.

Pay attention to age-specific vital sign ranges and equipment sizes.

Communicate effectively with both the child and their caregivers to gain necessary information and provide reassurance.

Be mindful of the emotional needs of both the child and their caregivers during the emergency response.

Geriatric Emergencies:

Older adults often have multiple comorbidities and may be taking multiple medications, increasing the complexity of their care.

Be aware of age-related changes such as decreased sensory perception, reduced mobility, and altered pharmacokinetics.

Consider the potential for polypharmacy and drug interactions.

Falls are a common emergency in the elderly population; assess for underlying causes and potential injuries.

Pregnancy-Related Emergencies:

Pregnant patients require special consideration due to physiological changes associated with pregnancy.

Assess for obstetric emergencies such as pre-eclampsia, eclampsia, placental abruption, and preterm labor.

Position the patient in a left lateral recumbent position to alleviate pressure on the vena cava and improve blood flow to the fetus.

Monitor both maternal and fetal well-being throughout the transport process.

Emergencies Involving Disabled Patients:

Disabled patients may have specific mobility, communication, or sensory needs that must be addressed during the emergency response.

Assess the patient's ability to communicate verbally and adjust communication methods accordingly.

Be prepared to provide assistance with mobility devices or specialized equipment.

Consider the potential impact of the patient's disability on their medical condition and treatment options.

Overall, EMS providers should approach special population emergencies with sensitivity, adaptability, and a comprehensive understanding of the unique needs and considerations associated with each group. 

Ongoing education and training specific to special populations can enhance providers' ability to deliver high-quality care in these situations. 

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell

EMS Mnemonic - CUPS

EMS providers should be familiar with the CUPS mnemonic when it comes to pediatric patient assessment, as it provides a systematic approach to categorizing and prioritizing patients based on their clinical status.

Here's a summary of what EMS providers need to know about CUPS:

C - Critical:

Definition: Patients in this category have absent airway, breathing, or circulation.

Action: Requires immediate and rapid interventions, as well as urgent transport.

Reassessment: Must be reassessed frequently to monitor and respond to changes in the patient's condition.

U - Unstable:

Definition: Patients with compromised airway, breathing, or circulation along with altered mental status.

Action: Requires rapid interventions and transport.

Reassessment: Similar to critical patients, unstable patients need frequent reassessment to ensure ongoing stability.

P - Potentially Unstable:

Definition: Patients with normal ABCs but present with significant illness or injury.

Action: Requires initial assessments with prompt interventions.

Assessment: A focused physical assessment and history are important during transport.

S - Stable:

Definition: Patients with normal ABCs and without significant illness or injury.

Action: Requires a focused physical assessment and history during routine transport.

EMS providers should use the CUPS mnemonic as a guide to determining the urgency of treatment and transport for pediatric patients.

It helps prioritize interventions based on the severity of the patient's condition.

Regular reassessment is emphasized for critical and unstable patients to adapt to changing conditions and provide appropriate care throughout the transport process.

Familiarity with such mnemonics is essential for effective and efficient pediatric patient management in emergency situations.

EMS Pediatric Populations - Infant Emergencies

EMS providers should be well-prepared to handle common infant emergencies, especially those related to respiratory illness and household accidents. 

Here's a guide for EMS providers on these aspects:

Common Infant Respiratory Emergencies:

Bronchiolitis:

• Typically caused by respiratory syncytial virus (RSV).

• Infants may present with wheezing, coughing, and respiratory distress.

• Administer oxygen and consider bronchodilators. Transport promptly if needed.

Croup:

• Viral infection causing inflammation of the upper airway.

• Characterized by a barking cough and stridor.

• Provide humidified oxygen and consider corticosteroids. Transport if respiratory distress persists.

Pneumonia:

• Bacterial or viral infection affecting the lungs.

• Signs include fever, cough, and respiratory distress.

• Administer oxygen and transport promptly for appropriate medical intervention.

Apnea:

• Sudden cessation of breathing, particularly in premature infants.

• Administer positive pressure ventilation as needed and transport urgently.

Foreign Body Aspiration:

• Infants are at risk of inhaling small objects.

• Perform back blows and chest thrusts if airway obstruction is suspected. Transport for further evaluation.

Household Accidents:

Choking:

• Infants are prone to choking on small objects.

• Perform age-appropriate choking maneuvers (e.g., back blows, chest thrusts).

• Assess and manage the airway. Transport if necessary.

Falls:

• Common household hazard.

• Assess for signs of injury and transport for further evaluation if needed.

Burns:

• Scald burns from hot liquids are common.

• Cool burns with tepid water. Do not use ice. Transport for further care.

Poisoning:

• Infants may ingest household products.

• Contact poison control for guidance and transport for medical evaluation.

Sudden Infant Death Syndrome (SIDS):

• Sudden, unexplained death of an otherwise healthy infant.

• Focus on providing emotional support to the family and prompt transport to a medical facility.

General Considerations:

1. Airway Management:

Maintain a clear airway and provide appropriate respiratory support.

2. Oxygen Administration:

Administer supplemental oxygen as needed.

3. Monitoring:

Continuously monitor vital signs and assess the infant's overall condition.

4. Transport Decisions:

Transport infants promptly, especially in cases of respiratory distress or when there is uncertainty about the severity of the situation.

5. Family Communication:

Provide clear and compassionate communication with the family, keeping them informed about the infant's condition and the plan of care.

EMS providers should receive specialized training in pediatric emergencies, stay updated on protocols, and collaborate with healthcare professionals for the best outcomes in infant emergencies.

EMS Pediatric Populations - Pediatric Emergencies

EMS providers should have knowledge and skills to effectively manage pediatric emergencies.

Here are some key points they should know:

1. Pediatric Assessment: Understanding the differences in anatomy, physiology, and vital signs between adults and children is crucial. Providers should be skilled in performing a thorough pediatric assessment, including assessing airway, breathing, circulation, disability, and exposure (ABCDE).

2. Airway Management: Pediatric airways are smaller and more easily obstructed than adult airways. Providers should be proficient in managing pediatric airway emergencies, including using appropriate airway adjuncts and techniques such as bag-mask ventilation and endotracheal intubation.

3. Respiratory Distress: Common respiratory emergencies in children include asthma, bronchiolitis, and croup. Providers should be familiar with respiratory assessment, oxygen therapy, and administering nebulized medications.

4. Cardiac Arrest and CPR: Pediatric cardiac arrest requires prompt recognition and intervention. Providers must be skilled in pediatric cardiopulmonary resuscitation (CPR), including chest compressions, ventilation, and the use of automated external defibrillators (AEDs).

5. Fever and Sepsis: Fever is a common presentation in pediatric patients. EMS providers should recognize signs of serious bacterial infections, sepsis, and know how to provide appropriate supportive care during transport.

6. Allergic Reactions: Anaphylaxis and severe allergic reactions can be life-threatening. Providers should be trained in recognizing and managing allergic emergencies, including the administration of epinephrine.

7. Trauma: Pediatric trauma may present differently than adult trauma. Providers should know how to assess and manage common pediatric injuries, including fractures, head injuries, and burns. They should also consider the psychological needs of the child and provide age-appropriate support.

8. Seizures: Seizures can occur in children due to various causes. Providers should be familiar with seizure recognition, seizure management, and appropriate administration of anti-seizure medications.

9. Dehydration: Children are more prone to dehydration due to their smaller fluid reserves. Providers should be able to assess and manage pediatric patients with suspected dehydration, including fluid resuscitation if necessary.

10. Communication and Psychological Support: Effective communication with both the child and their parents or caregivers is vital. Providers should use age-appropriate language, provide reassurance, and involve parents or caregivers in the decision-making process.

These are general considerations, and ongoing training and education in pediatric emergency care are essential for EMS providers to ensure optimal care for children in emergencies.