Hamele M, Poss WB, Sweney J. Disaster preparedness, pediatric considerations in primary blast injury, chemical, and biological terrorism. World J Crit Care Med 2014; 3(1): 15-23 [PMID: 24834398 DOI: 10.5492/wjccm.v3.i1.15]
Corresponding Author of This Article
Mitchell Hamele, MD, Division of Pediatric Critical Care, Department of Pediatrics, School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, United States. Mitchell.Hamele@hsc.utah.edu
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Review
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Atropine 0.05 mg/kg iv or im q 2-5 min (max 5 mg) Pralidoxime 25 mg/kg iv or im q 1 h (max 1 g iv or 2 g im) Benzodiazepines: Midazolam im 0.2 mg/kg (max 10 mg) (1st choice) Lorazepam iv/im 0.1 mg/kg (max 4 mg) Diazepam iv 0.3 mg/kg (max 10 mg)
Atropine should be repeated for persistent symptoms
Cyanide
Hydroxocobalamin 70 mg/kg (max 5 g) or sodium nitrate; 0.33mL/kg iv (max 10 mL) followed by sodium thiosulfate (25%) 1.65 mL/kg iv (max 50 mL)
Hydroxocobalamin may be repeated × 1 if needed
Table 3 Guidelines for the use of Mark I kits in pediatric patients
Pediatric patients
Mark I kits
3-7 yr (approximately 13-25 kg)
One Mark I kit as maximum dose
8-14 yr (approximately 26-50 kg)
Two Mark I kits as maximum dose
> 14 yr (approximately > 51 kg)
Three Mark I kits as maximum dose
Table 4 Management of biologic agents
Agent
Pediatric dosing
Notes
Inhalational anthrax
Ciprofloxacin 10-15 mg/kg iv q 12 h (max 400 mg) or doxycycline 2.2 mg/kg iv q 12 h (max 100 mg) plus clindamycin 10-15 mg/kg q 8 plus penicillin G 400-600 k U/kg per day iv divided q 4 h prophylaxis for exposed contacts ciprofloxacin 15 mg/kg po q 12 h or doxycycline 2.2 mg/kg po q 12 h
Switch to oral therapy when patient shows signs of improvement At least one agent should have good CNS penetration Prophylaxis is for a 60 d course Amoxicillin or levofloxacin are second line
Plague
Gentamycin 2.5 mg/kg iv q 8 h or streptomycin 15 mg/kg im q 12 h (max 2 mg/d) or doxycycline 2.2 mg/kg iv q 12 h (max 200 mg/d) or ciprofloxacin 15 mg/kg iv q 12 h prophylaxis for exposed contacts trimethoprim/sulfa 4 mg/kg po q 12 h
Chloramphenical or Levofloxacin can also be used Prophylaxis should be continued for 5-7 d
Tularemia
Same as therapy for plague
Botulism
Infants < 1 yr human-derived botulinum immunoglobulin children > 1 yr equine serum botulism antitoxin
In United States call 1-800-222-1222 or 770-488-7100 Outside United States contact local health agencies
Table 5 Viral hemorrhagic fever, virus and disease
Family
Virus
Disease
Arenaviruses
Lassa virus
Lassa fever
Junin
Argentine hemorrhagic fever
Machupo
Bolivian hemorrhagic fever
Bunyaviruses
CCHF
Cremiean-Congo hemorrhagic fever
RVF
Rift Valley fever
Hantavirus
Hemorrhagic fever with renal syndrome
Filoviruses
Ebola virus
Ebola hemorrhagic fever
Marburg virus
Marburg hemorrhagic fever
Flavivirus
Yellow fever virus
Yellow fever
KFD virus
KFD
OHF virus
Omsk hemorrhagic fever
DENV 1-4 viruses
Dengue hemorrhagic fever
Rhabdovirus
Bas-Congo virus
Bas-Congo hemorrhagic fever
Citation: Hamele M, Poss WB, Sweney J. Disaster preparedness, pediatric considerations in primary blast injury, chemical, and biological terrorism. World J Crit Care Med 2014; 3(1): 15-23