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Pediatric Terrorism and Disaster Preparedness

Public Health Emergency Preparedness

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Table 5.3. Representative Classes of Industrial Chemicals—Summary of Pediatric Management Considerations

Agent Clinical Findings Onset Decontamination Managementa
Strong acids/bases. Eye: caustic injury
Skin: chemical burns
GI: chemical burns of mouth, larynx, esophagus, stomach.
Rapid. Eye, skin: immediate copious water irrigation
GI: defer, immediate emergency department referral.
Supportive care, early endoscopy for significant ingestion; antibiotics and steroids controversial, should be individualized, consult Poison Control Centera.
Respiratory tract irritants (e.g., ammonia, HCl and HF gases). EENT and respiratory tract irritation with cough, chest pain, dyspnea, wheeze (possible pulmonary edema in severe cases). Rapid. Move to fresh air. Supportive respiratory care (consider nebulized calcium gluconate solution for HF, consult Poison Control Center).
Fentanyl and other opioids. CNS and respiratory depression, miosis. Rapid. Move to fresh air (for aerosol exposure), consider AC for ingestion, consult Poison Control Center. Supportive care, naloxone (0.01-0.1 mg/kg).
Cellular asphyxiants (e.g., phosphine, sodium azide). Cough, dyspnea, headache, dizziness, vomiting, tachycardia, hypotension, severe metabolic acidosis; may progress to coma, seizures, death; may have delayed onset pulmonary edema with phosphine. Rapid (except pulmonary edema with phosphine). Move to fresh air (consider AC for ingested sodium azide—caution with vomitus, which may emit toxic hydrazoic acid fumes; consult Poison Control Center). Airway, breathing, and circulatory support; 100% oxygen.
Arsine. Severe hemolysis. 2-4 hr. Move to fresh air. Supportive care, enhance urine flow, consider alkalinization, consult Poison Control Center.

a  Monitor respiratory status and blood pressure.

Note: Remember airway, breathing, circulation, decontamination/drugs. Consider oxygen, bronchodilators, nasogastric tube/drainage, ophthalmic analgesia, mydriatics, temperature control. If prolonged impairment of consciousness, electroencephalogram (EEG) (to rule out nonconvulsive status epilepticus) and imaging.

Source: Adapted from Rotenberg JS, Newmark J. Pediatrics 2003;112:648-58.

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