Chapter 68 - Medical Management of Chemical Toxicity in Pediatrics

Abstract

Chemical terrorism is the intentional use of toxic chemicals to inflict mass casualties on an unsuspecting population. Use of conventional chemical warfare agents (CWAs) and toxic industrial chemicals by terrorists on a civilian population will quickly overwhelm public health resources and emergency medical services. Toxic chemicals can quickly incapacitate those who are exposed and can lead to mortality if not recognized and treated promptly. In particular, the toxicity of these agents can be increased in children due to their vulnerabilities. While the toxicity and treatment of chemical agents in adult populations have been the focus of numerous reviews, publications, and textbooks, it is critical to recognize the different ways that children may react to toxicity compared to adults. Therapeutic dosing in pediatrics to treat chemical casualties is also different than adult medicine because it is weight based. In this chapter, the chemical threat agents and weapons of opportunity most likely to be used by terrorists to inflict casualties are examined, as well as a brief historical account and unique challenges of managing pediatric chemical casualties. The sections devoted to each chemical agent highlight the pediatric-relevant vulnerabilities and treatment guidelines for medical management. The final two sections of the chapter discuss the decontamination of children and recommendations to help prepare healthcare managers and providers in the event of a chemical event.