Pediatric emergency medicine trisk 4571 4571
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TABLE 132.5
AUTOINJECTOR ADMINISTRATION OF NERVE-AGENT
ANTIDOTES FOR INITIAL THERAPY OF SEVERELY AFFECTED
MASS CASUALTIES OR IN PREHOSPITAL SETTING
Atropine
Approximate age
Approximate weight (kg)
Autoinjector size (mg) a
<6 mo
<7.5
0.25
6 mo–4 yrs
7.5–18
0.5
5–10 yrs
18–30
1
10 yrs
>30
2 (adult size)
Pralidoxime b (or combination pralidoxime/atropine c )
Approximate age
(yrs)
Approximate weight (kg)
Number of autoinjectors
3–7
13–25
1
8–14
26–50
2
14
>50
3
Diazepam (10 mg each, for seizures, or severe exposure)
Approximate age
(yrs)
Number of autoinjectors
5–Adolescent
Adolescent and
older
1
2
a Administer
one autoinjector of each size indicated.
autoinjectors (e.g., 2 mg of atropine, 600-mg pralidoxime, combination of 2.1-mg atropine
and 600-mg pralidoxime or 10-mg diazepam), while not approved for pediatric use, might be considered as
initial treatment in dire (especially prehospital) circumstances, for children with severe, life-threatening
nerve-agent toxicity who lack intravenous access, and for whom more precise, mg/kg IM dosing (as per
Table 132.4 ) would be logistically impossible. Suggested pralidoxime dosing guidelines are offered: Note
potential excess of initial dose for age/weight, although within general guidelines for recommended total
over first 60–90 min of therapy of severe exposures.
c The combination autoinjectors may also be used for children in these age and size categories, as noted, to
replace both atropine and pralidoxime for initial therapy in severe cases. Such use will result in moderate
excess dosage of both antidotes, but again, generally within the guidelines for recommended total over the
first 60–90 min of therapy for severe exposures.
b Adult-intended
