Public Health Emergency Preparedness
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Table 5.3. Representative Classes of Industrial Chemicals—Summary of Pediatric Management Considerations
||Eye: caustic injury
Skin: chemical burns
GI: chemical burns of mouth, larynx, esophagus, stomach.
||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).
||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.
||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
||Airway, breathing, and circulatory support; 100% oxygen.
||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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