Biomedical Engineering Reference
In-Depth Information
pathophysiology, clinical manifestations and treat-
ment are found in Chapter(s) 6. Similar to biolog-
ical agents, little pediatric data exist concerning
effects of chemical warfare agents. Some data
regarding vesicant exposure comes from reports
of pediatric victims exposed during the Iran-Iraq
War [28]. Evidence also suggests that many chil-
dren died from chemical exposures, possibly a
combination of vesicants and nerve agents in the
village of Halabja during Saddam Hussein's Anfal
campaign.
Wet decontamination is recommended following
liquid exposures to nerve agents, vesicants and
pulmonary agents [5]. Decontamination should
be performed by personnel wearing appro-
priate personal protective equipment (PPE, see
Chapter 7). Wet decontamination ideally should
be provided in the field prior to hospital transport
or outside of the hospital structure if required for
patients arriving for care. Life-saving resuscitation
measures such as airway support with endotracheal
intubation and emergent antidotal therapy should
be given concomitantly with decontamination.
All clothing and jewelry must be removed and
double-bagged in plastic. This measure alone typi-
cally removes between 80-90% of contamination.
Victims should have skin and hair washed and irri-
gated with tepid water and mild soap. Any eye
exposure should receive copious normal saline irri-
gation [29]. Warm clean clothing and blankets for
children who undergo wet decontamination will
help prevent hypothermia from convective heat
loss during the procedure.
chloramphenicol (25mg/kg four times daily) are
recommended [24].
10.3.5 Tularemia
Tularemia is naturally occurring and has several
different manifestations including ulceroglandular,
glandular, oculoglandular, oropharyngeal, pneu-
monic, typhoidal, and septic forms. A pneumonic
infection is most likely following an aerosolized
release. Treatment recommendations for children
are the same as for plague [25].
10.3.6 Viral Hemorrhagic Fevers
The virus families Filoviridae, Arenaviridae,
Bunyaviridae, and Flaviviridae comprise the viral
hemorrhagic fevers. Specific agents, such as Ebola
virus, Lassa and Yellow fever cause a clinical
syndrome of fever, rash, DIC and hemorrhage 2-21
days after exposure with mortality ranging from
<1% to 90% depending on the infecting organism.
Intravenous ribavirin is recommended for clinically
evident viral hemorrhagic fever of unknown origin
or identified arenavirus or bunyavirus infection.
Dosing is weight-based and the same for children
and adults. Oral dosing is recommended in mass
casualty settings. The pediatric dose is 30 mg/kg
once followed by 15mg/kg twice a day for 10
days [26].
10.3.7 Botulinum Toxin
Aerosolized botulinum toxin produces a
descending paralysis by preventing acetylcholine
release at the motor end plate. Children and
adults would be expected to have the same clin-
ical presentation. However, children, especially
infants, would be expected to be more vulnerable
to paralysis and respiratory failure following
exposure. Equine botulinum antitoxin is the
primary therapy. Indications and dosing are the
same for adults and children [27].
10.3.9 Nerve Agents
Chemical nerve agents produce marked inhi-
bition of the enzyme, acetylcholinesterase, and
thereby prevent the breakdown of acetyl-
choline at muscarinic, nicotinic and central
nerve synapses. The clinical effects of bronch-
orrhea, miosis, diaphoresis, vomiting, diarrhea,
salivation, lacrimation and urination derive from
enhanced cholinergic transmission at pre- and
post-synaptic muscarinic nerve terminals. Fascic-
ulations and then paralysis follow initial depolar-
ization and then depolarizing blockade of nicotinic
10.3.8 Chemical Agents
The main classes of weaponized chemicals include
nerve agents, vesicants, pulmonary agents, cyanide
and riot control agents. Detailed discussion of
