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Decontamination in Children

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181. Meningitis (Overview)

of meningitis. In addition, it is the most common bacterial agent in meningitis associated with basilar skull fracture and CSF leak. It may be associated with other focal infections, such as pneumonia, sinusitis, or endocarditis (as, for example, in Austrian syndrome, which is the triad of pneumococcal meningitis, endocarditis, and pneumonia). S pneumoniae is a common colonizer of the human nasopharynx; it is present in 5-10% of healthy adults and 20-40% of healthy children. It causes meningitis by escaping (...) in epidemics (< 3% of cases). Currently, N meningitidis is the leading cause of bacterial meningitis in children and young adults, accounting for 59% of cases. Risk factors for meningococcal meningitis include the following: Deficiencies in terminal complement components (eg, membrane attack complex, C5-C9), which increases attack rates but is associated with surprisingly lower mortality rates Properdin defects that increase the risk of invasive disease Antecedent viral infection, chronic medical illness

2014 eMedicine.com

182. Hematopoietic Stem Cell Transplantation (Overview)

patients) Ganciclovir, IV immunoglobulin (IVIg), and CMV-negative blood products (CMV-seronegative patients) Pneumocystis prophylaxis with trimethoprim-sulfamethoxazole or pentamidine Prophylaxis of pneumococcal bacteremia with penicillin, erythromycin, or extended-spectrum fluoroquinolones (immunosuppressed GVHD patients) IVIg (patients with documented hypogammaglobulinemia) Gut decontamination with metronidazole or fluoroquinolones (acute GVHD) Hepatitis B virus (HBV) vaccine (all HBsAg-negative (...) Leukocyte adhesion deficiency Indications for HSCT in specific diseases Acute myeloid leukemia Allogeneic HSCT is the treatment of choice for all children with acute myeloid leukemia (AML) with a human leukocyte antigen (HLA) ̶ matched sibling in their first complete remission (CR1). In adults, this is reserved for those with high-risk features in their CR1. In adults with standard or good risk features, stem cell transplantation is reserved for their second complete remission (CR2). HSCT is the only

2014 eMedicine.com

183. Lice (Overview)

things with a fine-tooth comb" are part of everyday vocabulary. Louse infestation remains a major problem throughout the world, making the diagnosis and treatment of louse infestation a common task in general medical practice. [ ] Pediculosis capitis results in significant psychological stress in children and adults and missed schooldays in children, particularly in areas with a no-nit policy. [ ] Lice are ectoparasites that live on the body. Lice feed on human blood after piercing the skin (...) are spread by sitting on a toilet seat; pubic lice’s feet are not designed to walk on smooth surfaces such a toilet seats, and the lice cannot live for long away from a warm human body. [ ] Because these organisms are most often spread through close or intimate contact, P pubis infestation is classified as an STD. Condom use does not prevent transmission of P pubis . Upon diagnosis of pubic lice, concern should be raised about the possibility of concomitant STDs. In children, infestation of pubic lice

2014 eMedicine.com

184. Digitalis Toxicity (Overview)

tachycardia with heart block and bidirectional ventricular tachycardia are particularly characteristic of severe digitalis toxicity See for more detail. Management Supportive care of digitalis toxicity includes the following: Hydration with IV fluids Oxygenation and support of ventilatory function Discontinuation of the drug, and, sometimes, the correction of electrolyte imbalances GI decontamination Activated charcoal is indicated for acute overdose or accidental ingestion Binding resins (eg (...) the first-line treatment for significant dysrhythmias from digitalis toxicity. Other indications for its use, in the absence of specific contraindications, include the following: Ingestion of massive quantities of digitalis (in children, 4 mg or 0.1 mg/kg; in adults, 10 mg) Serum digoxin level greater than 10 ng/mL in adults at steady state (ie, 6-8 hours after acute ingestion or at baseline in chronic toxicity) Hyperkalemia (serum potassium level greater than 5 mEq/L) Altered mental status attributed

2014 eMedicine.com

185. MRSA Skin Infection in Athletes (Overview)

, and sharing of personal items. [ ] Populations reportedly at risk for CA-MRSA outbreaks specifically include military recruits, children in day care, prison inmates, homosexual men, injection drug users, and veterinarians, particularly those who have contact with swine. [ , , ] A study by Jiménez-Truque et al assessed colonization of S. aureus in 377 athletes and trainers and reported that the prevalence ranged from 34% to 62%, and 8% to 29% for MRSA. The study also reported a significantly higher (...) , which may result in cross-resistance to clindamycin Doxycycline: Administer 100 mg PO twice daily; this agent is not recommended for children younger than 8 years Linezolid: Administer 600 mg PO twice daily; note that cost often prohibits the use of this agent Note that ciprofloxacin has a 33% sensitivity in some areas. Therefore, this drug is not recommended due to resistance and reports of clinical failures despite in vitro susceptibility. The susceptibility of CA-MRSA is dependent on local

2014 eMedicine.com

186. Viral Hemorrhagic Fevers (Overview)

disease outbreak in Sierra Leone, it was found that chest pain, symptoms of confusion, coma and viral load greater than 10 6 copies/mL were significantly associated with a poor prognosis. Viral load was the most important factor that affected the survival of patients from the disease. [ ] A total of 278 human cases were confirmed with Rift Valley fever in the recent outbreak in South Africa in 2010-2011, with 25 deaths. Children can develop dengue hemorrhagic shock syndrome (DHSS), a complication (...) such spread can be prevented by implementing infectious disease safety and contact precautions, such as the following: Equipment sterilization Isolation of individuals who are infected Barrier nursing Educate health care workers and others about decontamination procedures, such as the use of hypochlorite or phenolic disinfectants. For patient education resources, see the , as well as . Previous References Racsa LD, Kraft CS, Olinger GG, Hensley LE. Viral Hemorrhagic Fever Diagnostics. Clin Infect Dis

2014 eMedicine.com

187. Enterococcal Infections (Treatment)

against E faecalis strains. Linezolid, an oxazolidinone antibiotic, is available orally and intravenously and is used to treat infections caused by E faecium and E faecalis strains, including VRE. Linezolid may be particularly useful in patients who require oral or outpatient therapy (when intravenous therapy is undesirable), who are intolerant to glycopeptides, or who have impaired renal function. [ ] Linezolid has been FDA-approved for use in infants and children. [ ] Unfortunately, linezolid (...) bloodstream infections and rectal colonization decreased significantly during the enhanced infection-control period. The risk of VRE acquisition in hospitalized patients is increased when environmental culture results are positive and/or when a room has been occupied by a patient with VRE colonization or infection. [ ] Adequate environmental cleaning should be a priority. Simple educational interventions directed at the housekeeping staff can improve decontamination of environmental surfaces. [ ] Bathing

2014 eMedicine.com

188. Inhalants (Treatment)

(recognizing that haloperidol may decrease underlying seizure thresholds). Remember that sudden death in these patients often involves sudden or strenuous activity; therefore, minimize patient agitation as much as possible. Measure electrolytes, including potassium, calcium, and phosphorus and replete as necessary because abnormal values can exacerbate cardiac dysrhythmias and muscle weakness. GI decontamination is generally not recommended. Specific laboratory tests and antidotes may be indicated (...) Jun. 41(2):135-43. . Henretig F. Inhalant abuse in children and adolescents. Pediatr Ann . 1996 Jan. 25(1):47-52. . Howard MO, Perron BE, Sacco P, Ilgen M, Vaughn MG, Garland E, et al. Suicide ideation and attempts among inhalant users: results from the national epidemiologic survey on alcohol and related conditions. Suicide Life Threat Behav . 2010 Jun. 40(3):276-86. . Jones HE, Balster RL. Inhalant abuse in pregnancy. Obstet Gynecol Clin North Am . 1998 Mar. 25(1):153-67. . Linden CH. Volatile

2014 eMedicine.com

189. Jellyfish Stings (Treatment)

when available. On very rare occasion, it may be helpful if rescuers can safely identify the species of jellyfish, but in general it is not necessary to identify the animal to guide treatment. Risking injury in an attempt to capture the animal is discouraged. To prevent further injury to the patient, the following decontamination steps are important: Inactivate nematocysts: Vinegar or acetic acid in solutions of 4-6% is the most widely accepted treatment of initial stings. Pour vinegar over (...) Medical Center Disclosure: Nothing to disclose. Jeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center Disclosure: Merck, Salary, Employment What would you like to print? What would you like to print? Sections Cnidaria Envenomation Find Us On About Membership WebMD Network Editions All material on this website is protected by copyright, Copyright © 1994-2019 by WebMD LLC

2014 eMedicine.com

190. MRSA Skin Infection in Athletes (Treatment)

, and sharing of personal items. [ ] Populations reportedly at risk for CA-MRSA outbreaks specifically include military recruits, children in day care, prison inmates, homosexual men, injection drug users, and veterinarians, particularly those who have contact with swine. [ , , ] A study by Jiménez-Truque et al assessed colonization of S. aureus in 377 athletes and trainers and reported that the prevalence ranged from 34% to 62%, and 8% to 29% for MRSA. The study also reported a significantly higher (...) , which may result in cross-resistance to clindamycin Doxycycline: Administer 100 mg PO twice daily; this agent is not recommended for children younger than 8 years Linezolid: Administer 600 mg PO twice daily; note that cost often prohibits the use of this agent Note that ciprofloxacin has a 33% sensitivity in some areas. Therefore, this drug is not recommended due to resistance and reports of clinical failures despite in vitro susceptibility. The susceptibility of CA-MRSA is dependent on local

2014 eMedicine.com

191. Mercury (Treatment)

> Mercury Toxicity Treatment & Management Updated: Nov 05, 2018 Author: David A Olson, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS Share Email Print Feedback Close Sections Sections Mercury Toxicity Treatment Approach Considerations Notify state and local health officials to clarify the mechanism of exposure and to institute appropriate decontamination measures, should these be necessary. Treatment of mercury toxicity consists of removal (...) deposits resulted in good outcomes with minimal toxicity. Inpatient care All patients in unstable condition should be admitted to an intensive care unit (ICU). After the patient is admitted, supportive measures, decontamination, and careful monitoring should be continued. In cases of inorganic mercuric salt ingestion, carefully monitor the patient's renal function. Transfer Serious clinical manifestations due to mercury exposure should be managed in a tertiary care facility by physicians experienced

2014 eMedicine.com

192. Digitalis Toxicity (Treatment)

Digitalis Toxicity (Treatment) Digitalis Toxicity Treatment & Management: Approach Considerations, GI Decontamination and Enhanced Elimination, Treatment of Electrolyte Imbalance Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTU0MzM2LXRyZWF0bWVudA== processing > Digitalis Toxicity Treatment & Management Updated: Jan 04, 2017 Author: Vinod Patel, MD; Chief Editor: Jeffrey N Rottman, MD Share Email Print Feedback Close Sections Sections Digitalis Toxicity Treatment Approach Considerations The clinical manifestations digoxin toxicity are the same in infants, children, and adults, and the treatment is the same across all these age groups. [ ] Treatment of digoxin toxicity should be guided by the patient’s signs and symptoms and the specific

2014 eMedicine.com

193. Hematopoietic Stem Cell Transplantation (Treatment)

patients) Ganciclovir, IV immunoglobulin (IVIg), and CMV-negative blood products (CMV-seronegative patients) Pneumocystis prophylaxis with trimethoprim-sulfamethoxazole or pentamidine Prophylaxis of pneumococcal bacteremia with penicillin, erythromycin, or extended-spectrum fluoroquinolones (immunosuppressed GVHD patients) IVIg (patients with documented hypogammaglobulinemia) Gut decontamination with metronidazole or fluoroquinolones (acute GVHD) Hepatitis B virus (HBV) vaccine (all HBsAg-negative (...) Leukocyte adhesion deficiency Indications for HSCT in specific diseases Acute myeloid leukemia Allogeneic HSCT is the treatment of choice for all children with acute myeloid leukemia (AML) with a human leukocyte antigen (HLA) ̶ matched sibling in their first complete remission (CR1). In adults, this is reserved for those with high-risk features in their CR1. In adults with standard or good risk features, stem cell transplantation is reserved for their second complete remission (CR2). HSCT is the only

2014 eMedicine.com

194. Lice (Treatment)

water and dried with hot air since the lice and eggs are killed after 5 minutes of exposure to temperatures greater than 53.5°C (128.3°F). [ ] Items that cannot be laundered can be dry-cleaned or sealed in a plastic bag for 2 weeks. [ ] The floors and furniture should be vacuumed in order to remove hairs from an infested individual, which might have been shed with viable nits attached. [ ] Children should also be educated not to share combs, brushes, hair accessories, and towels (...) (RID foam). [ ] Malathion lotion 0.5% is currently not US Food and Drug Administration (FDA) approved to treat pubic lice. Pyrethrin and permethrin kill live lice, but not unhatched eggs. A second treatment 9 days after the first treatment is recommended in order to kill any newly hatched lice before they can produce new eggs. Pyrethrin is derived from chrysanthemums and is approved for use in children aged 2 years or older. It should not be used by individuals who are allergic to chrysanthemums

2014 eMedicine.com

195. Laceration, Eyelid (Treatment)

segments will facilitate globe repair. Although repair of lid lacerations can be delayed, early repair may allow better corneal protection, less tissue edema, and better wound decontamination. If the lid repair must be delayed in favor of more life-threatening injuries, perform the following: Ensure adequate corneal lubrication. Clean the wound as much as possible. Keep the wound moist. A plastic occlusive dressing, like that used to cover intravenous sites, can be lightly applied over antibiotic (...) . In uncooperative, inebriated patients, it may be better to delay the repair until the patient is sober. Other uncooperative patients or children may require . Administering topical anesthetic drops and topical lidocaine gel followed by placing a corneal protector, when possible, is one preferred method. The corneal protector can be inserted with sterile gloves prior to anesthetic injection. Injecting anesthetic with epinephrine prior to wound cleansing affords better patient cooperation and wound visualization

2014 eMedicine.com

196. Pediculosis (Follow-up)

water and dried with hot air since the lice and eggs are killed after 5 minutes of exposure to temperatures greater than 53.5°C (128.3°F). [ ] Items that cannot be laundered can be dry-cleaned or sealed in a plastic bag for 2 weeks. [ ] The floors and furniture should be vacuumed in order to remove hairs from an infested individual, which might have been shed with viable nits attached. [ ] Children should also be educated not to share combs, brushes, hair accessories, and towels (...) (RID foam). [ ] Malathion lotion 0.5% is currently not US Food and Drug Administration (FDA) approved to treat pubic lice. Pyrethrin and permethrin kill live lice, but not unhatched eggs. A second treatment 9 days after the first treatment is recommended in order to kill any newly hatched lice before they can produce new eggs. Pyrethrin is derived from chrysanthemums and is approved for use in children aged 2 years or older. It should not be used by individuals who are allergic to chrysanthemums

2014 eMedicine.com

197. Q Fever (Follow-up)

) did not affect resolution of acute disease or severity of neurologic sequelae. [ ] Macrolides, especially azithromycin and clarithromycin, can also be used as alternative agents, but some strains of C burnetii show resistance. [ ] Trimethoprim-sulfamethoxazole (TMP-SMZ) has also been used. [ , ] No reliable regimen is available for children (< 8 y) or pregnant women. Macrolides or TMP-SMZ may be options in these populations. [ , ] Adjuvant corticosteroid treatment has been used in antimicrobial (...) populations should be screened for glucose-6-phosphate dehydrogenase deficiency before receiving hydroxychloroquine. If hydroxychloroquine is used, a yearly ophthalmologic evaluation is required to rule out retinal toxicity. Patients should be reminded of photosensitivity risk while on doxycycline therapy. Previous Next: Prevention C burnetii must be cultured in biosafety level 3 laboratories. Use only seronegative sheep in research facilities. Isolation and decontamination with standard precautions

2014 eMedicine.com

198. Nosocomial Pneumonia (Follow-up)

nutritional deficiencies. Early (within 48 hours) enteral nutrition appears to decrease infectious complications. Parenteral nutrition does not seem to have this effect and should be considered only in patients with a contraindication to enteral replacement. [ , ] Beds that permit some degree of patient turning may decrease the likelihood of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) in at-risk patients. Decontamination of the mouth and gut may affect the risk of producing MDR (...) -associated tracheitis in children: does antibiotic duration matter?. Clin Infect Dis . 2011 Jun. 52(11):1324-31. . . Siempos II, Vardakas KZ, Manta KG, Falagas ME. Carbapenems for the treatment of immunocompetent adult patients with nosocomial pneumonia. Eur Respir J . 2007 Mar. 29(3):548-60. . Kullar R, Davis SL, Levine DP, Rybak MJ. Impact of vancomycin exposure on outcomes in patients with methicillin-resistant Staphylococcus aureus bacteremia: support for consensus guidelines suggested targets. Clin

2014 eMedicine.com

199. Lice (Follow-up)

water and dried with hot air since the lice and eggs are killed after 5 minutes of exposure to temperatures greater than 53.5°C (128.3°F). [ ] Items that cannot be laundered can be dry-cleaned or sealed in a plastic bag for 2 weeks. [ ] The floors and furniture should be vacuumed in order to remove hairs from an infested individual, which might have been shed with viable nits attached. [ ] Children should also be educated not to share combs, brushes, hair accessories, and towels (...) (RID foam). [ ] Malathion lotion 0.5% is currently not US Food and Drug Administration (FDA) approved to treat pubic lice. Pyrethrin and permethrin kill live lice, but not unhatched eggs. A second treatment 9 days after the first treatment is recommended in order to kill any newly hatched lice before they can produce new eggs. Pyrethrin is derived from chrysanthemums and is approved for use in children aged 2 years or older. It should not be used by individuals who are allergic to chrysanthemums

2014 eMedicine.com

200. Jellyfish Stings (Follow-up)

when available. On very rare occasion, it may be helpful if rescuers can safely identify the species of jellyfish, but in general it is not necessary to identify the animal to guide treatment. Risking injury in an attempt to capture the animal is discouraged. To prevent further injury to the patient, the following decontamination steps are important: Inactivate nematocysts: Vinegar or acetic acid in solutions of 4-6% is the most widely accepted treatment of initial stings. Pour vinegar over (...) Medical Center Disclosure: Nothing to disclose. Jeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center Disclosure: Merck, Salary, Employment What would you like to print? What would you like to print? Sections Cnidaria Envenomation Find Us On About Membership WebMD Network Editions All material on this website is protected by copyright, Copyright © 1994-2019 by WebMD LLC

2014 eMedicine.com

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