Pediatric emergency medicine trisk 4572 4572
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Adapted from Henretig FM, Cieslak TJ, Eitzen EM Jr. Biological and chemical terrorism. J Pediatr
2002;141:311–326. Copyright © 2002 Elsevier. With permission
FIGURE 132.7 Autoinjector-packaged pralidoxime can be injected into an empty vial for
subsequent reuse in small pediatric patients. (Reprinted from Henretig FM, Mechem C, Jew R.
Potential use of autoinjector-packaged antidotes for treatment of pediatric nerve agent toxicity.
Ann Emerg Med 2002;40:405–408. Copyright © 2002 American College of Emergency
Physicians. With permission.)
Specific Pediatric Considerations. The thinner skin of children might make
them more susceptible to dermal absorption of chemical toxins in comparison to
adults ( Table 132.2 ). Likewise, the immature blood–brain barrier in infants
might increase the relative risk of CNS toxicity. Children have smaller airway
diameters, anatomic subglottic narrowing, and higher respiratory rates as well as
exhibit limited endurance of the accessory muscles of breathing; these
characteristics could predispose to earlier and more severe respiratory effects
from nerve agents. In addition, children have a greater susceptibility to seizures.
Although OP-pesticide poisoning in children may certainly manifest by dramatic
muscarinic findings, including respiratory compromise (see Chapter 102
Toxicologic Emergencies ), one case series of anticholinesterase pesticide
poisoning in children found that depressed sensorium and muscle weakness and
flaccidity were more prominent than muscarinic findings. Nevertheless, more
than half of these patients did demonstrate miosis (80%), tearing and excess
salivation (60%), and GI findings (52%). Other studies have shown an absence of
