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Decontamination in Children

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41. CRACKCast E163 – Pesticides

not be used in infants younger than 2 months old. DEET in concentrations of more than 30% should not be used in children and may result in neurotoxicity and self-limited seizure activity if used in excessive amounts. Most rodenticide exposures will be superwarfarin compounds. For large exposures, INR should be checked at a minimum of 2 days after ingestion. Vitamin K should be used for reversal; blood products should be used for active bleeding. Rosen’s In Perspective Pesticide is a general term (...) waiting for laboratory confirmation of decreased cholinesterase activity. Other laboratory studies should focus on the evaluation of pulmonary, cardiovascular, and renal function and fluid and electrolyte balance. A measurement of acid-base status should be performed, because patients with acidosis have higher mortality than those without. Treatment of organophosphate poisoning is directed toward four goals: (1) Decontamination Start this out of hospital!! Protect more people from getting affected

2018 CandiEM

42. Tide Pod Challenge: Managing caustic laundry pod ingestions

can be severe in some cases, given that the chemicals in pods are in very high concentration. As a result, it is crucial that those on the front line are familiar with how to handle these emergencies. 1 EPIDEMIOLOGY Laundry pod ingestion can present in a variety of populations. These exposures are generally divided into: (1) intentional (in persons with suicidal ideation and more recently the “Tide Pod Challenge”), (2) accidental (in children or adults with dementia), and (3) incidental (due (...) , and/or vomiting, drooling, or food refusal with or without oropharyngeal burns). Prompt endoscopy is required, and should be done in <12 hours, and not >24 hours due to risk of iatrogenic perforation. MANAGEMENT Decontamination takes priority. Staff should wear appropriate PPE as required, and should remove soiled clothing from patient to prevent dermal burns. Staff may be exposed to the caustic agent through vomit, and careful care should be taken around this. The first line of management is to stabilize

2018 CandiEM

43. CRACKCast Episode 149 – Aspirin and Nonsteroidal Agents

mechanism Tinnitus: Cochlear toxicity is thought to be the result of alterations in N-methyl-D-aspartate (NMDA) activity, decreased blood flow, and increased membrane permeability [2] What is the toxic dose of ASA? Mild – moderate toxicity = 150-300 mg/kg Severe toxicity = > 300 mg/kg Ingestions of >500 mg/kg are associated with death. Fatal salicylate intoxication can occur after the ingestion of 10 to 30 g by adults and as little as 3 g by children . Death typically results from severe central nervous (...) responds to supportive measures. Ibuprofen is the most common NSAID ingested in overdose and most cases follow a benign, self-limited course. Symptomatic overdose occurs only after ingestion of at least 100 mg/kg, and symptoms develop within 4 hours of ingestion. Life-threatening toxicity is rare with most cases limited to mild GI disturbance that resolves in hours. Treatment: Decontamination: There is no evidence supporting the use of gastric emptying or AC in NSAID overdoses. Enhanced Elimination

2018 CandiEM

44. CRACKCast E147 – General Approach to the Poisoned Patient

this toxicology stuff is: Make diagnosis / or suspect the ingestion/exposure/overdose/toxicity Ask those five W’s and H’s Who took it? What did they take, and any other co-ingestions? When did they take it? Where did they take it (packer, stuffer, IV, PO, Intranasal, transdermal, rectal)? Why did they take it (i.e. suicide vs occupational vs accidental) ? How MUCH did they take? Initiate decontamination Prevent absorption Enhance drug elimination Give any antidotes When it comes to history, get as much (...) : Activated charcoal is a carbonaceous substance that has been exposed to high heat and steam, resulting in a large surface area to volume ratio, to provide ample surface space for ingested substances to adsorb, and thus decrease absorption into the body Activated charcoal historically has most often been given in a dose of 25 to 100 grams (10 to 25 grams or 0.5 to 1.0 gram/kilogram in young children) Customize the dose to the dose of the ingested agent by administering activated charcoal in a weight

2018 CandiEM

45. CRACKCast E193 – Disaster Preparedness

. Planners should establish and exercise a hospital-based incident management system. Disaster planning needs to include policies to address the needs of vulnerable populations, such as children, disabled, and the elderly. Rosen’s in Perspective: Disasters occur all over the world, regardless of governments, wars, poverty, or wealth Double-hit: not only do you have large numbers of people injured, but you also can have damage to the infrastructure used to care for those patients. Increasing population (...) ’) Personnel: roster of all critical positions and the personnel who will fill them, including backup persons for each position. A policy for managing volunteers (especially uncontrolled or unscheduled volunteers who often appear at hospitals in the case of a disaster and can be disruptive) Patient Management: protocols for decontamination, triage, prioritization, and evacuation of patients Training Exercises: all essential departments should participate in regular scheduled drills, including community

2018 CandiEM

46. CRACKCast E191 – Weapons of Mass Destruction

if the unthinkable should happen. Shownotes – Key concepts Emergency department (ED) preparedness for a radiation incident should address decontamination (an external freestanding decontamination unit is best), triage, staff safety, personal protective equipment (PPE), and diagnostic procedures that emphasize radiation monitoring. It is important that emergency personnel know their radiation safety officer. Management of acute life-threatening conditions takes priority over radiation-associated issues. Aerosol (...) dispersal is a likely route that terrorists may use to deploy biologic weapons, so victims will present primarily with respiratory complaints. In addition to “flulike” symptoms, anthrax typically causes mediastinal widening, pulmonary consolidation, and pleural effusions best seen on chest computed tomography (CT) scans. Smallpox can spread in a hospital environment; thus, patients thought to have smallpox should be admitted to locations separated from the rest of the hospital. Decontamination is a key

2018 CandiEM

47. CRACKCast E157 – Iron and Heavy Metals

decontamination method of choice for iron and lead toxicity with radiographic presence of pills or paint chips is WBI. The chelation agent of choice for acute arsenic poisoning is intramuscular British anti-lewisite (BAL) or oral succimer. Elemental mercury is nontoxic to the gastrointestinal tract but may cause pulmonary and CNS toxicity from inhalation of volatilized Vapors. Rosen’s in Perspective Iron OD in children used to be a big killer, but nowadays with new FDA regulations there are few deaths. Iron (...) preparations with non-ionic iron have MUCH lower toxicity = i.e. no reported cases of serious toxicity! 2. What amount of ingested iron / iron level constitutes Mild toxicity/Moderate toxicity/Severe toxicity? Ingesting 60mg/kg LD50 (50% mortality) = 200-250 mg/kg That being said doses as little as 130 mg in children have been lethal. Peak serum iron below 350 μg/dL is generally associated with minimal toxicity; 350 to 500 μg/dL (90

2018 CandiEM

48. CRACKCast E153 – Caustics

undergo endoscopy and be considered for admission. Asymptomatic patients can undergo endoscopy in the emergency department or be discharged with close follow-up monitoring. Gastric emptying or GI decontamination is not indicated for the majority of caustic ingestions. Concentration and pH are the most important characteristics of a substance to predict esophageal and gastric injury. Button batteries lodged in the airway or esophagus require endoscopic retrieval. Rosen’s In Perspective Caustic (...) , formaldehyde, iodine, and concentrated hydrogen peroxide. Most oral injuries are intended for self harm. Some may be accidental (children drinking from water bottle that held an acid). Some household products, such as liquid drain cleaners, continue to have high concentrations of alkali (30% KOH) or acid (93% H2SO4) (Table 148.1). These products often do not have concentration or content information available on the label, making it difficult for clinicians to determine the severity of exposure. Industrial

2018 CandiEM

49. Use of Central Venous Catheters in Neonates - a Framework for Practice

of insertion with 2% Chlorhexidine/ 70% isopropyl alcohol and allow to dry for 30 seconds. 8 Cover baby and surrounding area with sterile drape. 9 Remove outer gloves prior to catheter insertion. 10 Maintain sterile field. After the procedure 11 Secure catheter with umbilical fixation (UAC/UVC) or sterile transparent dressing (PICC). 12 Decontaminate hands after removal of gloves. 13 Complete documentation in the patient notes including insertion record sticker. Comments: NO YES British Association (...) bundles effective in critically ill neonates and children? Intensive Care Med. 2013;39:1352-8. 6. Sinha AK, Murthy V, Nath P, et al. Prevention of late onset sepsis and central line associated blood stream infection in preterm infants. Pediatr Infect Dis J. 2015 ePub Nov 30. 7. Bliss. Intravenous lines and catheters. http://www.bliss.org.uk/intravenous-lines- and-catheters (accessed 22nd December 2015). 8. Dunn PM. Localization of the umbilical catheter by post-mortem measurement. Arch Dis Child

2018 British Association of Perinatal Medicine

50. CRACKCast E165 – Sedative Hypnotics

mental status. CXR = look for pulmonary edema or aspiration Consider neuroimaging +/- EEG to rule out non-convulsive status Management ABCs Intubate as needed Fluids +/- pressors for hypotension (watch out for pulmonary edema) Decontamination Potentially MDAC (but no evidence for improved outcome) Consult your local toxicologist Enhanced Elimination Urine Alkalinization = controversial Hemodialysis serum levels over 100 mcg/mL refractory hypotension renal or cardiac failure acid-base or electrolyte (...) irritation or damage = V/D, esophagitis, hemorrhagic gastritis, and, rarely, gastrointestinal perforation or necrosis Transient hepatic or renal dysfunction can also occur. Dosing Danger The hypnotic oral adult dose=0.5 to 1.0 g. The toxic oral dose = ~ 10 g in adults may be as little as 1.5 g in children. Onset of action is 20 to 30 minutes. Chloral hydrate and ethanol in combination (historically referred to as a “Mickey Finn”) potentiate each other’s action to produce rapid loss of consciousness

2018 CandiEM

51. The use of faecal microbiota transplant as treatment for recurrent or refractory Clostridium difficile infection and other potential indications

or refractory CDI, but non-CDI indica- tions are also considered. These guidelines only apply to adult patients (=18 years); the working party did not consider the role of FMT in the treatment of either CDI or non-CDI indications in children or young people. The guidelines were written with a focus on UK practice, but also with consideration of more global practice as it applied. The diagnosis and management of CDI in general are outside the remit of these guidelines. 4.3. Evidence appraisal Questions

2018 British Society of Gastroenterology

52. Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies

guidelines for the management of paediatric tracheostomy emergencies Corresponding Author Consultant E-mail address: Department of Paediatric Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK Correspondence to: C. Doherty Email: Consultant Paediatric Intensive Care Medicine, Paediatrics, Birmingham Children's Hospital, Birmingham, UK Tracheostomy Specialist Nurse Department of Paediatric ENT, Manchester University NHS Foundation Trust, Manchester, UK Tracheostomy Specialist Nurse (...) , Burnley, UK Specialty Trainee Department of Paediatric Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK Professor, Consultant Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK Manchester Academic Health Science Centre, Manchester, UK Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK Consultant Department of Paediatric Otolaryngology, Royal

Full Text available with Trip Pro

2018 Association of Paediatric Anaesthetists of Great Britain and Ireland

53. Use of Central Venous Catheters in Neonates

of insertion with 2% Chlorhexidine/ 70% isopropyl alcohol and allow to dry for 30 seconds. 8 Cover baby and surrounding area with sterile drape. 9 Remove outer gloves prior to catheter insertion. 10 Maintain sterile field. After the procedure 11 Secure catheter with umbilical fixation (UAC/UVC) or sterile transparent dressing (PICC). 12 Decontaminate hands after removal of gloves. 13 Complete documentation in the patient notes including insertion record sticker. Comments: NO YES British Association (...) bundles effective in critically ill neonates and children? Intensive Care Med. 2013;39:1352-8. 6. Sinha AK, Murthy V, Nath P, et al. Prevention of late onset sepsis and central line associated blood stream infection in preterm infants. Pediatr Infect Dis J. 2015 ePub Nov 30. 7. Bliss. Intravenous lines and catheters. http://www.bliss.org.uk/intravenous-lines- and-catheters (accessed 22nd December 2015). 8. Dunn PM. Localization of the umbilical catheter by post-mortem measurement. Arch Dis Child

2018 British Association of Perinatal Medicine

54. Materials for retrograde filling in root canal therapy. (PubMed)

Materials for retrograde filling in root canal therapy. Root canal therapy is a sequence of treatments involving root canal cleaning, shaping, decontamination and obturation. It is conventionally performed through a hole drilled into the crown of the affected tooth, namely orthograde root canal therapy. For teeth that cannot be treated with orthograde root canal therapy, or for which it has failed, retrograde root filling, which seals the root canal from the root apex, is a good alternative (...) . Many materials, such as amalgam, zinc oxide eugenol and mineral trioxide aggregate (MTA), are generally used. Since none meets all the criteria an ideal material should possess, selecting the most efficacious material is of utmost importance.To determine the effects of different materials used for retrograde filling in children and adults for whom retrograde filling is necessary in order to save the tooth.Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral

2016 Cochrane

55. CRACKCast E120 – Dermatologic presentations

in children and young adults. The etiology is unknown. Clinical presentation includes multiple pink or pigmented oval papules or plaques 1 to 2 cm in diameter on the trunk and proximal extremities. A history may reveal an initial larger patch (“herald patch”) that precedes the widespread eruption. The lesions are parallel to the ribs, forming a Christmas tree–like distribution on the trunk and extremities. “In children, papular or vesicular variants of the disease may occur. Pityriasis rosea is self (...) Infection of the skin caused by staph. Aureus or beta-hemolytic strep. (More surrounding erythema) MRSA may also be involved Usually in children Bullous impetigo is another common form: the toxin released from staphylococcus causing 1-2 cm bullae Ddx: HSV, inflammatory fungal infection, contact dermatitis, pemphigus vulgaris. Treatment: (usually a self limited dz in 3-6 wks.) PO abx for severe or multiple lesions Cephalexin MRSA: Septra Doxy Clindamycin Bullous impetigo: Erythromycin or azithromycin

2017 CandiEM

56. Roadmap for Zoonotic Tuberculosis

safety practices play a central role in the control of many zoonotic diseases, both at the household and the commercial level. Interventions targeting M. bovis will also reduce transmission of other important foodborne diseases; for example, illness caused by Brucella, Campylobacter, Escherichia coli, Salmonella and Listeria spp. Such interventions can be highly cost- and resource-effective. Pasteurization, the decontamination of milk through exposure to high temperatures for a specified period (...) workers, abattoir workers, butchers and livestock traders; ? children and those more likely to consume unpasteurized milk and dairy products; and ? immunocompromised people, such as those living with HIV/AIDS. Cultural practices can influence food consumption behaviours. In many parts of the world, dairy systems often lack specialized equipment for collecting, treating and processing milk, which may be influenced by cultural and/or economic factors. For example, groups such as the Fulani in West

2017 International Union Against TB and Lung Disease

57. Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities

Kong SAR, China), Nalini Singh (Children’s National Medical Center and George Washington University, USA), Evelina Tacconelli (University Hospital Tübingen, Germany), Maha Talaat (CDC Global Disease Detection Programme, Egypt), Akeau Unahalekhaka (Chiang Mai University, Thailand). WHO Steering Group The following WHO experts served on the WHO Steering Group: Benedetta Allegranzi (Department of Service Delivery and Safety), Sergey Eremin (Antimicrobial Resistance Secretariat), Bruce Gordon (Water

2017 World Health Organisation Guidelines

58. Iodine thyroid blocking: Guidelines for use in planning and responding to radiological and nuclear emergencies

) or repeated exposure, unavoidable ingestion of contaminated food and drinking water, and where evacuation is not feasible. Neonates, pregnant and breastfeeding women and people older than 60 years, should not receive repeated ITB due to the risk of adverse effects. The following considerations should be kept in mind when administering ITB: ¦ Children, adolescents, pregnant and breastfeeding women, are most likely to benefit from ITB, whereas individuals over 40 years of age are less likely to benefit from (...) it. 8 / IODINE THYROID BLOCKING ¦ Should the supply of stable iodine be limited, priority should be given to the children and younger adults. ¦ Individuals at risk of exposure to high doses of radioactive iodine (e.g. emergency workers involved in rescue or clean-up operations) are likely to benefit from ITB irre- spective of their age and should be given priority. ¦ People living in iodine deficient areas are more likely to be affected by exposure to radioactive iodine. In such places, national

2017 World Health Organisation Guidelines

59. The Use of Laser Irradiation in Adjunct with Calcium Hydroxide Treatment of Direct Pulp Capping Procedures Leads to Higher Success Rates than Calcium Hydroxide Alone

in the success of direct pulp capping procedures employing laser irradiation to provide hemostasis and decontamination of the pulp exposure before placement of calcium hydroxide. The success rates were determined by the percentage of vital teeth at the final follow-up appointments. This treatment is within the capability of the average general dentistry practice and is likely to be supported by the patient to increase the likelihood of keeping the tooth vital at minimal financial cost. Best Evidence (you may (...) view more info by clicking on the PubMed ID link) PubMed ID Author / Year Patient Group Study type (level of evidence) #1) Javed/2017 687 children and adults in 6 included studies with pulp exposures Meta-Analysis Key results The success rate for maintaining pulpal vitality was significantly higher in the treatment group compared to the control group (log odds ratio = 1.737; 95% confidence interval, 1.304 - 2.171). The meta-analysis found that 80% of the included studies showed that the use

2017 UTHSCSA Dental School CAT Library

60. Introduction to the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee Guideline for the Prevention of Surgical Site Infections

Site Infections Patient-related factors Age [ ] Obesity or malnutrition [ , , ] Diabetes or hyperglycemia [ ] Smoking [ ] Colonization [ , ] Remote infection [ ] Pre-operative hospital stay [ ] Procedure-related factors Instrument cleaning, decontamination, and sterilization Operating room ventilation [ ] Pre-operative shaving [ ] Surgical skin preparation [ , ] Surgical scrub [ ] Surgical technique [ ] Surgical drains [ ] Tourniquet time [ ] Revision arthroplasty [ ] Procedure duration [ , ] Table (...) tissue and pulmonary infections from community-associated MRSA has increased dramatically, particularly in children and young, immunocompetent adults [ ]. Although initially described as community-associated or community-onset MRSA, this strain is now quite common in healthcare settings and is replacing other strains of MRSA as a cause of HAIs [ ]. The USA300 strain also has become a common pathogen for SSIs; it is the most common form of S. aureus found in SSIs in hospitalized patients

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2017 Surgical Infection Society

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