248 lines
No EOL
14 KiB
HTML
248 lines
No EOL
14 KiB
HTML
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN"
|
|
"http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
|
|
<html xmlns="http://www.w3.org/1999/xhtml">
|
|
<head>
|
|
<title>Pediatric Terrorism and Disaster Preparedness: Table 5.2</title>
|
|
|
|
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
|
|
|
|
<!-- "metadata" -->
|
|
<meta name="description" content="Comprehensive report and summary for pediatricians to consult in planning for and responding to natural disasters and bioterrorist events." />
|
|
<meta name="keywords" content="Agency for Health Care Policy and Research, Agency for Healthcare Research and Quality, AHRQ, AHCPR, bioterrorism, community resources, disaster preparedness, emergency, hospital, mass casualty event, public health, surge capacity, urgent care" />
|
|
|
|
<link href="/includes/archive.css" rel="stylesheet" type="text/css" />
|
|
<link href="/includes/ahrqstyleprint_arch.css" rel="stylesheet" type="text/css" media="print" />
|
|
<script>
|
|
(function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){
|
|
(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),
|
|
m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)
|
|
})(window,document,'script','//www.google-analytics.com/analytics.js','ga');
|
|
|
|
ga('create', 'UA-75759936-1', 'auto');
|
|
ga(' set', 'anonymizeIp', true);
|
|
|
|
ga('send', 'pageview');
|
|
|
|
</script></head><body><!-- Google Tag Manager -->
|
|
<noscript><iframe src="//www.googletagmanager.com/ns.html?id=GTM-W4DST4"
|
|
height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript>
|
|
<script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':
|
|
new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],
|
|
j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src=
|
|
'//www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);
|
|
})(window,document,'script','dataLayer','GTM-W4DST4');</script>
|
|
<!-- End Google Tag Manager -->
|
|
<noscript>
|
|
Your browser doesn't support JavaScript. Please upgrade to a modern browser or enable JavaScript in your existing browser.
|
|
</noscript>
|
|
|
|
<!-- Page Header v2.0 -->
|
|
<a name="top" id="top"></a>
|
|
<!--Begin Banner CodeS-->
|
|
<div id="ahrqbanner">
|
|
<div class="hhsportion">
|
|
<a href="#h1" class="skipnav">Skip Navigation</a>
|
|
<a href="http://www.hhs.gov" title="U.S. Department of Health and Human Services">
|
|
<img src="/images/hhs_banner.gif" alt="U.S. Department of Health and Human Services" />
|
|
</a>
|
|
<a href="http://www.hhs.gov" title="www.hhs.gov" class="hhsright">
|
|
<img src="/images/hhs_link.gif" alt="www.hhs.gov" />
|
|
</a>
|
|
</div>
|
|
|
|
<div class="ahrqportion">
|
|
<a href="/" title="Archive: Agency for Healthcare Research Quality">
|
|
<img src="/images/ahrq_banner.gif" alt="Agency for Healthcare Research Quality" />
|
|
</a><form name="searchForm" method="get" action="https://search.ahrq.gov/search" id="banner_searchform">
|
|
<label for="search" style="z-index:-1;position:relative;margin-right:-65px; font-size:0px;">Search</label>
|
|
<input name="q" type="text" value=" Search Archive" size="11" onfocus="this.value='';" class="gotext" label="Search archive" id="search" />
|
|
<input type="hidden" name="entqr" value="0" />
|
|
<input type="hidden" name="output" value="xml_no_dtd" />
|
|
<input type="hidden" name="proxystylesheet" value="ARCHIVE_Front_End" />
|
|
<input type="hidden" name="client" value="ARCHIVE_Front_End" />
|
|
<input type="hidden" name="site" value="ARCHIVE_AHRQ_GOV" />
|
|
<input src="/images/topbn_GoButton.gif" class="gobtn" name="Submit" onclick="javascript:document.searchForm.submit();" type="image" alt="Search" />
|
|
</form>
|
|
<a href="https://www.ahrq.gov/" class="ahrqright">www.ahrq.gov</a>
|
|
</div><div class="ahrqlinks"><a href="https://www.ahrq.gov/">AHRQ Home—Live Site</a> | <a href="/">Archive Home</a> | <a href="/sitemap.htm">Site Map</a> <!-- | <img src="/images/envelope1.jpg" alt="" width="21" height="14" /><a href="https://subscriptions.ahrq.gov/service/multi_subscribe.html?code=USAHRQ">E-mail Updates</a> --></div>
|
|
</div>
|
|
<div id="PrintBanner">
|
|
<img src="/images/printbanner_arch.jpg" alt="Archive print banner" />
|
|
</div>
|
|
<a name="h1"></a>
|
|
<!-- End banner code -->
|
|
<!-- End of Page header -->
|
|
|
|
<!-- Content Body -->
|
|
<div id="mainContent">
|
|
<table width="100%" border="0" cellspacing="0" cellpadding="0" >
|
|
<tr valign="top">
|
|
<td width="70%">
|
|
<!-- Center Content section -->
|
|
<table width="100%" border="0" cellpadding="0" cellspacing="0" style="margin-left:10px; margin-right:10px;margin-top:5px" summary="This table gives the layout format of the bread crumb area and the center content area.">
|
|
<!--DWLayoutTable-->
|
|
<tr>
|
|
<td class="crumb_link"><div id="crumbContent">
|
|
<p><strong>You Are Here:</strong> <span class="crumb_link"><a href="/" class="crumb_link">AHRQ Archive Home</a> > <a href="/prep/" class="crumb_link">Public Health Preparedness Archive</a> > <a href="." class="crumb_link">Pediatric Terrorism and Disaster Preparedness</a> > Table 5.2</span></p>
|
|
</div>
|
|
</td>
|
|
</tr>
|
|
<tr>
|
|
<td height="30px"><span class="title"><a name="h1" id="h1"></a>Pediatric Terrorism and Disaster Preparedness </span></td>
|
|
</tr>
|
|
<tr>
|
|
<td><div id="centerContent"><p><strong>Public Health Emergency Preparedness</strong></p> <div class="headnote">
|
|
|
|
<p>This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.</p>
|
|
<!-- <p>Now this resource is supported by the <a href="http://emergency.cdc.gov/">Centers for Disease Control and Prevention</a> (CDC).</p> -->
|
|
|
|
|
|
<p>This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: <a href="https://info.ahrq.gov/">https://info.ahrq.gov</a>. Let us know the nature of the problem, the Web address of what you want, and your contact information. </p>
|
|
|
|
|
|
<p>Please go to <a href="https://www.ahrq.gov/">www.ahrq.gov</a> for current information.</p></div>
|
|
|
|
<h3>Table 5.2. Chemical Weapons—Summary of Pediatric Management Considerations</h3>
|
|
|
|
<table border="1" cellspacing="0" cellpadding="3" width="95%">
|
|
<tr valign="top">
|
|
<th scope="col">Agent</th>
|
|
<th scope="col">Toxicity</th>
|
|
<th scope="col"><strong>Clinical Findings</strong></th>
|
|
<th scope="col"><strong>Onset</strong></th>
|
|
<th scope="col"><strong>Decontamination<sup><a href="#notea">a</a></sup></strong></th>
|
|
<th scope="col"><strong>Management</strong></th>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td colspan="6" scope="row"><strong>Nerve Agents </strong></td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td width="10%" scope="row"><p>Tabun<br />
|
|
Sarin<br />
|
|
Soman<br />
|
|
VX</p> </td>
|
|
<td width="15%">Anticholinesterase: muscarinic, nicotinic, and CNS effects.</td>
|
|
<td width="18%"><p><em>Vapor:</em> miosis, rhinorrhea, dyspnea.<br />
|
|
<em>Liquid:</em> diaphoresis, vomiting.<br />
|
|
<em>Both:</em> coma, paralysis,
|
|
seizures, apnea.</p></td>
|
|
<td width="18%"><p><em>Vapor:</em> seconds.<br />
|
|
<em>Liquid:</em> minutes-hours.</p></td>
|
|
<td width="20%"><p><em>Vapor:</em> fresh air, remove clothes, wash hair.<br />
|
|
<em>Liquid:</em> remove clothes, copious washing of skin and hair with soap and water, ocular irrigation.</p> </td>
|
|
<td width="19%"><p>ABCs.<br />
|
|
Atropine: 0.05 mg/kg IV<sup><a href="#noteb">b</a></sup>, IM<sup><a href="#notea">a</a></sup> (min 0.1 mg, max 5 mg), repeat
|
|
q2-5 min prn for marked secretions, bronchospasm.<br />
|
|
Pralidoxime: 25 mg/kg IV, IM (max 1 g IV; 2 g IM), may repeat within 30-60 min prn, then again every hour for 1 or 2 doses prn for persistent weakness, high atropine requirement.<br />
|
|
Diazepam: 0.3 mg/kg (max 10 mg) IV; lorazepam: 0.1 mg/kg IV, IM (max 4 mg); midazolam: 0.2 mg/kg (max 10 mg) IM prn for seizures or severe exposure.</p></td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td colspan="6" scope="row"><strong>Vesicants</strong></td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td scope="row">Mustard</td>
|
|
<td>Alkylation</td>
|
|
<td>Skin erythema, vesicles, ocular inflammation, respiratory tract inflammation.</td>
|
|
<td>Hours.</td>
|
|
<td>Wash skin with soap and water, ocular irrigation (major impact only if done within min of exposure).</td>
|
|
<td>Symptomatic care.</td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td scope="row">Lewisite</td>
|
|
<td>Arsenical</td>
|
|
<td>As above. </td>
|
|
<td>Immediate pain.</td>
|
|
<td>As above.</td>
|
|
<td>Possibly BAL 3 mg/kg IM q4-6hr for systemic effects in severe cases.</td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td colspan="6" scope="row"><strong>Pulmonary Agents </strong></td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td scope="row"><p>Chlorine<br />
|
|
Phosgene</p> </td>
|
|
<td>Liberate HCL, alkylation.</td>
|
|
<td>Eyes, nose, throat irritation (especially chlorine); bronchospasm, pulmonary edema (especially phosgene).</td>
|
|
<td><p>Minutes: eyes, nose, throat irritation; bronchospasm.<br />
|
|
Hours: pulmonary edema.</p> </td>
|
|
<td>Fresh air, wash skin with water.</td>
|
|
<td>Symptomatic care.</td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td colspan="6" scope="row"><strong>Cyanide</strong></td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td scope="row">Cyanide<br /></td>
|
|
<td>Cytochrome oxidase inhibition: cellular anoxia, lactic acidosis.</td>
|
|
<td>Tachypnea, coma, seizures, apnea.</td>
|
|
<td>Seconds.</td>
|
|
<td>Fresh air, wash skin with soap and water.</td>
|
|
<td><p>ABCs, 100% oxygen.<br />
|
|
Sodium bicarbonate prn for metabolic acidosis <br />
|
|
Sodium nitrite (3%):</p>
|
|
<p><em>Dosage (mL/kg) Estimated Hgb (g/dL)</em><br />
|
|
0.27 10.<br />
|
|
0.33 12 (est. for avg. child).<br />
|
|
0.39 14 (max 10 mL).</p>
|
|
<p>Sodium thiosulfate (25%): 1.65 mL/kg (max 50 mL).</p></td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td colspan="6" scope="row"><strong>Riot Control Agents </strong></td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td scope="row"><p>CS<br />
|
|
CN (eg, Mace®)<br />
|
|
Capsaicin (pepper spray)</p>
|
|
</td>
|
|
<td>Neuropeptide substance P release; alkylation.</td>
|
|
<td>Ocular pain, tearing, blepharospasm; nose and throat irritation; pulmonary
|
|
failure (rare).</td>
|
|
<td>Seconds.</td>
|
|
<td>Fresh air, ocular irrigation.</td>
|
|
<td>Topical ophthalmics, symptomatic care.</td>
|
|
</tr>
|
|
</table>
|
|
<p class="size2"><a name="notea" id="notea"></a><sup>a</sup> Should be performed by health care providers garbed in adequate personal protective equipment, especially if victims have had significant exposure to nerve agents or vesicants. For emergency department staff, adequate personal protective equipment (PPE) consists of a non-encapsulated, chemically resistant body suit, boots, and gloves with a full-face air purifier mask/hood.<br />
|
|
<a name="noteb" id="noteb"></a><sup>b</sup> Intraosseous route likely equivalent to intravenous.<br />
|
|
<a name="notec" id="notec"></a><sup>c</sup> Atropine via endotracheal tube or inhalation, or aerosolized ipratropium of possible benefit.</p>
|
|
|
|
<p class="size2"> <strong>Note:</strong> ABCs = airway, breathing, and circulatory support; BAL= British anti-lewisite; Hgb= hemoglobin concentration; prn = as needed; CNS = central nervous system ; IM = intramuscular.</p>
|
|
|
|
<p class="size2"><strong>Source:</strong> Adapted from Henretig FM, Cieslak TJ, Eitzen EM Jr. Biological and chemical terrorism. <em>J Pediatr</em> 141:311-26 © 2002, with permission from Elsevier. </p>
|
|
|
|
<p align="left" class="size2"><a href="pedchap5.htm#Tab5.2">Return to Document</a> </p>
|
|
<p> </p>
|
|
<div class="footnote">
|
|
<p> The information on this page is archived and provided for reference purposes only.</p></div>
|
|
<p> </p>
|
|
|
|
</div>
|
|
</td>
|
|
</tr>
|
|
</table>
|
|
<!-- End of Center Content section -->
|
|
</td>
|
|
</tr>
|
|
</table>
|
|
</div>
|
|
<!-- End of Content Body -->
|
|
<!-- Footer graphic 1.2-->
|
|
<table cellspacing="0" cellpadding="0" border="0" width="100%">
|
|
<tr>
|
|
<td width="125" background="/images/bottom_ahrq_bkg.jpg"><img src="/images/bottom_ahrq_1.jpg" width="125" alt="AHRQ" /></td>
|
|
<td width="100%" background="/images/bottom_ahrq_bkg.jpg" ><img src="/images/bottom_ahrq_bkg.jpg" width="10" height="34" alt="" /></td>
|
|
|
|
<td width="310" background="/images/bottom_ahrq_bkg.jpg"><img src="/images/bottom_ahrq_2.gif" alt="Advancing Excellence in Health Care" width="310" height="34" /></td>
|
|
</tr>
|
|
</table>
|
|
<!-- Footer links section -->
|
|
<div id="banner_Footer2"><p> <a href="https://www.ahrq.gov/">AHRQ Home</a> | <a href="https://info.ahrq.gov" class="footer_navlink">Questions?</a> | <a href="https://www.ahrq.gov/contact/index.html" class="footer_navlink">Contact AHRQ</a> | <a href="https://www.ahrq.gov/sitemap.html" class="footer_navlink">Site Map</a> | <a href="https://www.ahrq.gov/policy/electronic/accessibility/index.html" class="footer_navlink">Accessibility</a> | <a href="https://www.ahrq.gov/policy/electronic/privacy/index.html" class="footer_navlink">Privacy
|
|
Policy</a> | <a href="https://www.ahrq.gov/policy/foia/index.html" class="footer_navlink">Freedom of Information Act</a> | <a href="https://www.ahrq.gov/policy/electronic/disclaimers/index.html" class="footer_navlink">Disclaimers</a> | <a href="http://www.hhs.gov/open/recordsandreports/plainwritingact/index.html" class="footer_navlink">Plain Writing Act</a> <br />
|
|
|
|
<a href="http://www.hhs.gov" class="footer_navlink">U.S. Department of Health & Human Services</a> | <a href="http://www.whitehouse.gov" class="footer_navlink">The White House</a> | <a href="http://www.usa.gov" class="footer_navlink">USA.gov: The U.S. Government's Official Web Portal</a></p>
|
|
</div>
|
|
<div id="banner_Footeraddress"><p>Agency for Healthcare Research and Quality <img src="/images/bottom_dot.gif" alt="" /> 5600 Fishers Lane Rockville, MD 20857 <img src="/images/bottom_dot.gif" alt="" /> Telephone: (301) 427-1364</p></div>
|
|
|
|
<!-- End of Footer links section -->
|
|
</body>
|
|
</html> |