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Table 6.8. Antibiotics for treatment of post-radiation neutropenia Antimicrobial Dosage and Comments and spectrum of activity route First-choice antimicrobials (listed in order of potential efficacy) Cefepime 150 mg/kg divided q 8 h, IV or IM Not available in oral form. Activity against gram-positive organisms, except Enterococcus spp. Activity against gram-negative organisms, including Pseudomonas aeruginosa and certain Enterobacteriaceae that generally are resistant to most third-generation Ceftazidime Ceftriaxone Second-choice Gentamicin 100–300 mg/kg/day divided q 8 h 50–75 mg/kg/day, IV or IM, once a day 3–7.5 mg/kg/day divided q 8–24 h, IV or IM Amikacin 15–22.5 mg/kg/day divided q 8 h, IV or IM Third-choice Ciprofloxacin Levofloxacin Gatifloxacin 20-30 mg/kg/day divided q 12 h, PO, IV, or IM 10 mg /kg/day, PO, IV, or IM 10 mg/kg/day, PO or IV * Dosage: 25–50 mg/kg/day divided q 8 h, PO † Dosage: 40–60 mg/kg/day divided q 6–8 h, IV cephalosporins. May need to add amoxicillin* or vancomycin † Not available in oral form. Activity against gram-negative organisms, including Pseudomonas aeruginosa and certain Enterobacteriaceae that generally are resistant to most third-generation cephalosporins. Not available in oral form. Activity against gram-positive organisms, except Enterococcus spp. May need to add amoxicillin* or vancomycin † Not available in oral form. May need to add amoxicillin* or vancomycin † Not available in oral form. May need to add amoxicillin* or vancomycin † Effective against gram-negative organisms and atypical bacteria. Also effective against Pseudomonas species but poor coverage against gram-positive organisms (including Staphylococcus aureus and nonhemolytic streptococci). May need to add amoxicillin* or vancomycin † Effective against gram-negative organisms and atypical bacteria. More gram-positive coverage than ciprofloxacin. Expanded spectrum against both gram-negative and grampositive organisms. Can be administered as single agent. 233
Table 6.9. Threshold radioactive exposures and recommended prophylactic single doses of KI Predicted thyroid exposure (Gy) No. of 130-mg tablets No. of 65-mg tablets KI dose (mg) Adults >40 yr old ≥5 130 1 2 Adults 18–40 yr ≥0.1 130 1 2 Pregnant or lactating women ≥0.05 130 1 2 Adolescents 12– 18 yr old ≥0.05 130 1 2 Children 3–12 yr old ≥0.05 >65 ½ 1 Children 1 mo to 3 yr old ≥0.05 32 ¼ ½ Neonates birth to 1 mo old ≥0.05 16 1/8 ¼ Adapted from U.S. Department of Health and Human Services, FDA, Center for Drug Evaluation and Research. Potassium Iodide as a Thyroid Blocking Agent in Radiation Emergencies. Available at http://www.fda.gov/cder/guidance/4825fnl.htm. 234
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Bioterrorism and Other Public Healt
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Contents Chapter 1. Introduction ..
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Q Fever............................
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Basic Principles...................
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Chapter 9. Integrating Terrorism an
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Table 5.4 Nerve agent triage and do
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There are many gaps in knowledge, e
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injured or killed (see also Chapter
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Head injury is common in children.
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In situations of disaster, caregive
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maintaining and securing the airway
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• Schonfeld DJ. In times of crisi
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Types of Disasters Chapter 2. Syste
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problems noted above for flooding,
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Federal Response The United States
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The scope of ESF #8 is broad and in
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• Centers for Disease Control and
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Table 2.1 Types of disasters, hazar
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Medical staffs need to know what wi
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information, health and safety educ
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y private physicians. Approximately
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even required (particularly if a pe
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ICS structure is hierarchical. For
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• Provide community education so
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• Provide for crisis counseling.
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incident command officer is most of
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Figure 3.1 National Response Plan D
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Background History of Bioterrorism
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Epidemiology of a Terrorist Attack
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and may be watery, purulent, or blo
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fluid in these vesicles. A painless
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determined to be due to an agent of
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cared for using standard precaution
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may be providing longer term and mo
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The vaccine has a number of common
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Vaccination Large-scale vaccination
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cutaneous lesions; however, previou
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common food source is identified du
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treated people experience some degr
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treatment for plague meningitis. An
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Smallpox is spread most commonly in
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focal, intensely suppurative necros
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Control measures. Some viruses that
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Control measures. Person-to-person
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Signs and symptoms. The incubation
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currently used for individuals trav
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Accessed July 12, 2006. • Centers
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• Roffey R, Tegnell A, Elg HF. Bi
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Figure 4.2. Neurological signs, bot
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Figure 4.4. Physical distribution o
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Figure 4.6. Varicella lesions Note:
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Figure 4.8a. Febrile rash illness a
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Table 4.1. Early clinical signs and
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Table 4.2. Infection control transm
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Table 4.3. Diagnostic procedures, i
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Table 4.4a. Diagnostic tests for an
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Table 4.6. Treatment recommendation
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Introduction Chapter 5. Chemical Te
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likely manifest as an acute onset o
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exposures (Table 5.3). For an in-de
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Neuromuscular effects. At the neuro
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children. Finally, routine administ
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Treatment Management of cyanide poi
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Sulfur mustard is stockpiled both i
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decontamination is therefore extrem
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Pulmonary Agents Toxic industrial c
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Type I agents, the significance of
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After dispersal of riot control age
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• Kales SN, Christiani DC. Acute
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• Gray EA, Love JW, Arnold JL. CB
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Table 5.2. Chemical weapons - Summa
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Table 5.3 Representative classes of
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Table 5.4. Nerve agent triage and d
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Table 5.5. Clinical effects from su
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Table 5.7. Medical treatment of rio
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Chapter 6. Radiological and Nuclear
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from ground zero. For weapons large
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(1000 rem), resulting in four fatal
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cooling systems at Mayak exploded,
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pediatric practices. This put infan
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energy, releasing two photons of ex
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need to be shielded, although the a
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adioactive isotope of potassium. Ba
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An integrated, interactive human bo
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Biodosimetry and Radiological Terro
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primitive/progenitor cells and othe
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permits bacterial translocation and
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To assess radiation dose, a researc
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status? 4. Conduct an initial surve
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explosion, when it is concentrated
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Skin pathway. Although intact skin
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personnel should also take a wipe s
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• Geiger-Mueller or G-M counters
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• Protective clothing— Disposab
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Decontamination priorities are as f
Page 194 and 195: These effects can occur anywhere fr
Page 196 and 197: manifestations of ARS may range fro
Page 198 and 199: Neutropenia: Viral and Fungal Infec
Page 200 and 201: The main reason for targeting pregn
Page 202 and 203: No significant side effects from it
Page 204 and 205: axilla, groin, and skin folds. Radi
Page 206 and 207: Followup Care, Including Risk of Ca
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Page 210 and 211: adioactive material in an accident.
Page 212 and 213: 131, canned milk or other milk prod
Page 214 and 215: home immediately after the incident
Page 216 and 217: • National Council on Radiation P
Page 218 and 219: • U.S. Nuclear Regulatory Commiss
Page 220 and 221: Radiation Detection, PPE, Monitorin
Page 222 and 223: • National Council on Radiation P
Page 224 and 225: • Peter RU, Gottlober P. Manageme
Page 226 and 227: Recommendations for State and Local
Page 228 and 229: Figure 6.2. Environmental exposure
Page 230 and 231: Figure 6.4. Bone marrow irradiated
Page 232 and 233: Figure 6.6. Classic Andrews diagram
Page 234 and 235: Figure 6.8. Examples of radiation s
Page 236 and 237: Figure 6.10. Localized radiation ef
Page 238 and 239: Table 6.2. Biodosimetry based on ac
Page 240 and 241: Table 6.4. Diagnostic steps in acut
Page 242 and 243: Table 6.6. Dose assessment summary
Page 246 and 247: Table 6.10. Radionuclide specific t
Page 248 and 249: Introduction Chapter 7. Blast Terro
Page 250 and 251: Spalling effect. When a blast wave
Page 252 and 253: Clinical findings and diagnosis. Cl
Page 254 and 255: highest position. Because of the pr
Page 256 and 257: perilymph in the membranous labyrin
Page 258 and 259: • Hemoptysis. • Subcutaneous em
Page 260 and 261: management and immediately involve
Page 262 and 263: considered (see Chapter 4, Biologic
Page 264 and 265: • Circumstances (weather conditio
Page 266 and 267: Bibliography Explosives, Incendiary
Page 268 and 269: Trauma Systems and Planning/Mitigat
Page 270 and 271: Table 7.2 Spectrum of primary blast
Page 272 and 273: Table 7.3 Principles of Advanced Tr
Page 274 and 275: Determine the severity of the burn
Page 276 and 277: Chapter 8. Mental Health Issues Men
Page 278 and 279: • Amnesia for important parts of
Page 280 and 281: Treatment. Treatment should be guid
Page 282 and 283: • Before notifying the family, br
Page 284 and 285: • Be conscious of nonverbal commu
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Page 288 and 289: was mean to my father yesterday and
Page 290 and 291: these roles, they should work close
Page 292 and 293: • Lack of availability of trauma-
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The structure provided by a preexis
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necessarily meet the children’s n
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Make Psychological Contact Tune in
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A communications goal of “educati
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• Schonfeld D. Crisis interventio
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Chapter 9. Integrating Terrorism an
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Chain of command. A chain of comman
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The chain of command established by
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Advice for families of children wit
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Quarantine procedures. Quarantine p
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Chapter 10. Working with Government
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need under the 12 Emergency Service
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ecognizes that community clinicians
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Chapter 11. Conclusion This report
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Planning for special medical needs
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Table 11.1 Environmental constraint
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Table 11.2 Pediatric medical compla
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• The post-storm environment is h
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Acronyms AAP American Academy of Pe
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RIA RTG SCIWORA SEB SI SNS SSRI STA
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Appendix A. Pediatric Terrorism and
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1. List which biological agents (mi
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19. Identify chemical terrorism tox
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39. Provide followup care, being mi
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Learning Objectives: At the end of
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Lead Editors Appendix B. List of Co
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James Tsung, MD, FAAP Attending Phy
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Gerald S. Braley, PhD Major, United
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Kobi Peleg, PhD Michael Stein, MD J
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Lou E. Romig MD, FAAP, FACEP Childr
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Maternal & Child Health Bureau Dan
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