Biomedical Engineering Reference
In-Depth Information
PURPLE
SYNDROME SUSPECTED PRESUMPTIVE Rx ALTERNATIVE
AGENTS
Eye tearing Riot Control
None
only agents
'SLUDGE' Nerve agents
Atropine 0.2 mg IV (IM if hypoxic);
OR
await atropine effect;
Visual change
then 2-PAM 500 mg IV
OR
Small pupils
OR
Fasciculations
Cyanosis Nerve agents--->
see above
OR OR
Seizures Cyanide---------->
Na-nitrite 100 mg IV,
OR
then Na-thiosulfate 500 mg IV
Coma
Paralysis Botulinum
Trivalent antitoxin Pentavalent toxoid vaccine
(delayed) toxin
(Type A-B-E)
(Type A-B-C-D-E)
Pneumonic Anthrax
Ciprofloxacin 150 mg IV q 12 h Ciprofloxacin 150 mg IV q 12 h
(delayed) Plague
AND AND
Ricin
Streptomycin 100 mg IM q 12 h Gentamicin 15 mg IV q 8 h
Tularemia
OR
Doxycycline 22 mg IV q 12 h
10 KG 11 KG
Figure 10.3
Pediatric disaster assistance tool. Sample section for treatment of a 10-11 kg. Child, Side B, Treatment based on
presenting syndrome. Adapted by Carl Baum and Jim Wiley from the Broselow-Luten Coloring Kids System, Vitalsigns
®
(all rights
reserved).
11 cases of cutaneous anthrax resulted [17]. One
case of cutaneous anthrax infection was found in a
7-month-old male infant who had crawled around
on the floor in an office space at the New York
City Headquarters of a major news organization.
The child developed a large area of infection on the
arm that was initially misdiagnosed as cellulites and
treated as an outpatient after surgical debridement
and a single does of intravenous antibiotics. Subse-
quently, the child returned with worsening symp-
toms. Because of the lack of response, he was
admitted to the hospital with a diagnosis of Brown
Recluse Spider Bite. Ultimately, a diagnosis of
anthrax was made based on the history of possible
exposure and PCR confirmation of anthrax DNA
in a skin biopsy of the lesion and in serum. The
infant's course was complicated by hyponatremia,
hemolysis, DIC, and renal insufficiency. He made
a complete recovery [18]. This case represents the
only documented case of biological terrorism in a
child. The previously undescribed systemic effects
in this child raise the question of differential suscep-
tibility to complications of cutaneous anthrax in chil-
dren. No pulmonary cases occurred and also did
not occur in this child despite obvious exposure.
Whether children are less susceptible to this form of
disease after deliberate exposure remains an impor-
tant question for further investigation.
Because of possible engineered resistance,
ciprofloxacin is the drug of choice for infection
