Pediatric Terrorism and Disaster Preparedness: A ... - PHE Home

patient should be intubated promptly if there are any signs of laryngeal spasm or edema.
Direct bronschoscopy may be necessary for removal of obstructive pseudomembranes.
The need for prolonged intubation (>5–10 days) is a sign of significant proximal airway
damage and suggests a poor prognosis. The temptation to use systemic antibiotics during
the first 3–4 days despite the not uncommon findings of fever, leukocytosis, and cough
should be avoided to prevent the growth of resistant organisms. However, if these signs
and symptoms persist beyond this period and there is radiographic evidence of
consolidation, systemic antibiotics may then be indicated.
For severe GI effects, in addition to fluid replacement, antiemetics or anticholinergics
may be helpful. In the rare case of vesicant ingestion, gastric lavage may be useful if
performed within 30 minutes; vomiting should never be induced.
If anemia from bone marrow involvement is severe, blood transfusions may be of benefit.
Other therapies, such as administration of hematopoietic growth factors and bone marrow
transplantation, although used successfully in animal studies, have never been used in
people exposed to vesicants.
Pediatric Considerations
The unique susceptibilities of children (see Chapter 1, Children Are Not Small Adults)
emphasize the need to consider a number of practical treatment issues after vesicant
exposure. The first consideration is the time from exposure to onset of skin
manifestations, which is shorter in children than in adults. As a result, children may be
overrepresented in the initial index cases in a mass civilian exposure. Because a child’s
skin is more delicate, the caustic effects of decontamination agents (such as bleach) on an
already damaged skin surface are potentially much greater; consequently, these agents
should probably be avoided altogether in children. Soap and water used for washing and
rinsing should be warmed if possible to prevent the greater likelihood of hypothermia in
children. In addition, low water pressure (60 psi preferred; if not available,