Biomedical Engineering Reference
In-Depth Information
Table 10.3
Antidotes for children exposed to chemical warfare agents
Agent
Indication
Treatment
Nerve agents
a
Cholinergic effects:
Bronchorrhea, bradycardia, miosis, tearing,
drooling, vomiting, and diarrhea
Atropine 0.05-0.1mg/kg IM or IV (minimum 0.1mg,
maximum 5mg) every 2-5 minutes as needed for
marked secretions or bronchospasm.
Nicotinic (motor end plate):
Fasiculations, muscle weakness, and paralysis
Pralidoxime 25-50mg/kg IV (maximum 1 gm), IM
(maximum 2 gm) repeat in 30-60 minutes as
needed and then every hour for up to 2 doses as
needed. Pralidoxime may be given continuously as
infusion of 10-15mg/kg/hour (maximum
600mg/hr)
CNS: Seizures or prophylactically in severe
exposure
Lorazepam 0.1mg/kg IV, IM (maximum 4mg) OR
Midazolam 0.2mg/kg IM (maximum 10mg) OR
Diazepam 0.3mg/kg IV (maximum 10mg)
Lewisite
Bone marrow suppression and GI tract symptoms
British anti-lewisite (BAL) 3mg/kg every 4-6 hours
for severe symptoms
Cyanide
Dyspnea, coma, seizures, and apnea
Sodium nitrite (3%):
Hgb (estimated, g/dL) Dose (ml/kg)
10
0.27
12
0.33
14
0.39
Maximum 10ml.
Sodium thiosulfate (25%)
1.65ml/kg (Maximum 50ml)
a
see text for discussion of autoinjectors and Atropen™.
by its direct inhibition of electron transport in the
mitochondria. From the standpoint of a chemical
weapon, it is only effective in closed spaces. Rapid
treatment with sodium nitrite and sodium thio-
sulfate is necessary to salvage exposed victims.
Weight-based dosing in children is based on esti-
mated hemoglobin and is essential to avoid unto-
ward effects of excess methemoglobinemia from
sodium nitrite (Table 10.3) [29].
Treatment requires removal from exposure, decon-
tamination and supportive care and does not differ
significantly from adults [33].
10.3.14 Radiation
Extensive information exists regarding the health
effects of radiation exposure in children. Experi-
ence from survivors of Hiroshima, Nagasaki, and
Chernobyl indicate that, when controlled for expos-
ure level, radiation-induced cancers occur more
frequently in children than in adults. Protection
from radiation exposure consists of evacuation and
shelter. Potassium iodide provides protection from
thyroid uptake of radioactive iodine, an isotope
commonly found in nuclear power plants and likely
released after an incident [34]. Table 10.4 lists
age and weight-based dosing recommendations,
including how to prepare potassium iodide solu-
tion. The solution is stable for 7 days in the
refrigerator and should be given daily until author-
ities indicate that it is no longer needed [35].
10.3.13 Riot Control Agents
Modern riot control agents include the commonly
available pepper spray (
Oleoresin capsicum
),
CN (1-chloroacetophenone, Mace™) and CS
(2-chlorobenzylidene). These agents are chem-
ical irritants of the skin, eyes, upper airways,
and gastrointestinal tract. Typically, they are
incapacitating but not lethal. However, close expo-
sure in enclosed areas has caused serious upper
and lower airway disease in children. Pulmonary
deaths have occurred in previously healthy people.
