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Decontamination in Children

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161. Cryptosporidiosis (Treatment)

of diarrhea and can decrease the risk of mortality in malnourished children. [ ] Trials have also demonstrated efficacy in adults. [ , ] Trials of antiparasitic drugs in patients with AIDS and cryptosporidiosis have been disappointing. Nitazoxanide, paromomycin, and azithromycin are partially active. Combination antiretroviral therapy that includes an HIV protease inhibitor is associated with dramatic improvement in many cases. [ , ] Improvement is likely to result from immune reconstitution but may (...) effect on the oocysts, water purification should involve flocculation and filtration (using filters with a pore size of 1-4 μm). Ultraviolet radiation and ozonization are other means of disinfecting contaminated water. Decontamination can also be achieved by bringing water to a boil. Prompt, aggressive measures, including temporary closure of pools, must be carried out in cases of suspected fecal contamination of recreational water. People with diarrhea should not use recreational water, and those

2014 eMedicine.com

162. Anthrax (Treatment)

IgG1 kappa monoclonal antibody. [ ] Human anthrax immune globulin (Anthrasil) is indicated for treatment of inhalational anthrax in adults and children in combination with antibiotic therapy. [ ] The indication for anthrax vaccine adsorbed (BioThrax) was expanded in November 2015 to include postexposure use following suspected or confirmed B anthracis exposure in combination with antimicrobial therapy. It was originally approved for pre-exposure prophylaxis in high-risk individuals (...) outlined as recommended by the CDC, IDSA, and AAP (see table below). Table 3. CDC Expert Panel Recommendations for Treatment of Cutaneous Anthrax Nonpregnant adults Pregnant/lactating women Children Recommended therapy [ ] : Treatment duration, 7-10 days Ciprofloxacin 500 mg every 12 hours Ciprofloxacin 500 mg every 12 hours Ciprofloxacin 30 mg/kg/day divided every 12 hours (max dose, 500 mg/dose) Doxycycline 100 mg every 12 hours Amoxicillin 75 mg/kg/day divided every 8 hours (max dose, 1 g/dose

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2014 eMedicine.com

163. Burns, Chemical (Treatment)

, then this should be started immediately. Immediate removal of caustic substances in the eye is critical. [ ] Next: Emergency Department Care The first priority in treatment is to ensure complete removal of the offending agent. Thorough decontamination is key. Adequate irrigation is difficult to define and depends on the amount of exposure and the agent involved. Using litmus paper to measure the pH of the affected area or the irrigating solution is helpful. Complete removal and neutralization of concentrated (...) burns require the same fluid therapy as that for thermal burns. [ ] See . After initial decontamination, the full extent of the injury must be ascertained and the patient must be treated as a typical burn patient. Based on the degree of injury, ensure adequate fluid resuscitation and take precautions to prevent complications (eg, hypothermia, infection, rhabdomyolysis). Special situations Elemental metals The elemental forms of lithium, potassium, sodium, and magnesium react with water

2014 eMedicine.com

164. Bronchiolitis (Treatment)

relief but has been associated with longer hospitalization Nebulized hypertonic (3%) saline may improve symptoms of bronchiolitis when length of stay is expected to exceed 3 days Palivizumab prophylaxis should only be administered to selected children (se below) Hand decontamination is indicated to prevent nosocomial spread Infants should not be exposed to passive smoking, and clinicians should inquire about parental smoking and encourage cessation. Breastfeeding is recommended Clinicians should (...) of bronchiolitis, at present, only oxygen appreciably improves the condition of young children with bronchiolitis and many other medical therapies remain controversial. [ ] Bronchodilator therapy to relax bronchial smooth muscle, though commonly used, is not supported as routine practice by convincing evidence. If bronchodilator therapy is started, it may be continued in selected patients who demonstrate clinical improvement. Despite the prominent role that inflammation plays in the pathogenesis of airway

2014 eMedicine.com

165. Brucellosis (Treatment)

; resistance is not a significant issue in treating brucellosis. [ ] Depending on what other systems are involved, more specialized care may be needed. Transfer to another facility depends on the needs of the patient. Because most patients do not require highly specialized interventions, the need to transfer should not be frequent. Personnel involved in the transfer should maintain respiratory and contact precautions, and the vehicle should be decontaminated after transport as needed. Next: Initial (...) Supportive Care Given that the symptoms generally are vague and the presentation is rarely life-threatening, emergency medical service (EMS) care should focus on stabilization, as needed, and transport. As in the care of any patient with a potentially transmissible disease, appropriate precautions (eg, gloves, mask, and gown) should be used. If a proximate bioterrorist attack is known or strongly suggested at the time of patient contact, appropriate decontamination is warranted. In the event of a covert

2014 eMedicine.com

166. Nosocomial Pneumonia (Treatment)

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

167. Viral Hemorrhagic Fevers (Treatment)

, such as livestock or primates Taking safety precautions when coming in contact with potential intermediate hosts, for example, when handling slaughtered livestock or primates for scientific experimentation Preventing nosocomial transmissions by sterilizing equipment, such as needles; decontaminating and disinfecting facilities; isolating patients who are infected; practicing barrier nursing; and implementing safety infectious disease precautions and procedures Avoiding travel to areas known to have viral (...) Sep 22. 81(38):362-3. . Munir MA, Alam SE, Khan ZU, Saeed Q, Arif A, Iqbal R, et al. Dengue fever in patients admitted in tertiary care hospitals in Pakistan. J Pak Med Assoc . 2014 May. 64(5):553-9. . Heilman JM, De Wolff J, Beards GM, Basden BJ. Dengue fever: a Wikipedia clinical review. Open Med . 2014. 8(4):e105-15. . . Kirawittaya T, Yoon IK, Wichit S, Green S, Ennis FA, Gibbons RV, et al. Evaluation of Cardiac Involvement in Children with Dengue by Serial Echocardiographic Studies. PLoS Negl

2014 eMedicine.com

168. Pediculosis (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

169. Ventricular Fibrillation (Treatment)

for complications (eg, aspiration pneumonia, cardiopulmonary resuscitation [CPR]-related injuries), and establish the need for emergent interventions (eg, thrombolytics, antidotes, decontamination). Mild therapeutic hypothermia has been shown to improve neurologic outcomes and survival after out-of-hospital cardiac arrest and should be considered in appropriate patients. [ , ] Traditionally, a target temperature of 32°-34°C (89.6°-93°F) has been recommended. A study has shown, however, that in unconscious (...) . 113 (5):1298-307. . Driscoll DJ, Edwards WD. Sudden unexpected death in children and adolescents. J Am Coll Cardiol . 1985 Jun. 5 (6 suppl):118B-21B. . Myerburg RJ, Mitrani R, Interian A Jr, Castellanos A. Identification of risk of cardiac arrest and sudden cardiac death in athletes. In: Estes NA, Salem DN, Wang PJ, eds. Sudden Cardiac Death in the Athlete . Armonk, NY: Futura Publishing; 1996. 25. Young D, Mark H. Fate of the patient with the Eisenmenger syndrome. Am J Cardiol . 1971 Dec. 28 (6

2014 eMedicine.com

170. Q Fever (Treatment)

) 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

171. Toxicity, Organophosphate (Treatment)

Toxicity, Organophosphate (Treatment) Organophosphate Toxicity Treatment & Management: Decontamination, Medical Care, Surgical Care 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTY3NzI2LXRyZWF0bWVudA (...) == processing > Organophosphate Toxicity Treatment & Management Updated: Sep 22, 2018 Author: Kenneth D Katz, MD, FAAEM, ABMT; Chief Editor: Sage W Wiener, MD Share Email Print Feedback Close Sections Sections Organophosphate Toxicity Treatment Decontamination Remove all clothing from and gently cleanse patients suspected of organophosphate exposure with soap and water because organophosphates are hydrolyzed readily in aqueous solutions with a high pH. Consider clothing as hazardous waste and discard

2014 eMedicine.com

172. Toxicity, Mustard Agent (Treatment)

=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvODMyMDYwLXRyZWF0bWVudA== processing > CBRNE - Vesicants, Mustard - Hd, Hn1-3, H Treatment & Management Updated: Jan 02, 2018 Author: Daniel J Dire, MD, FACEP, FAAP, FAAEM; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD Share Email Print Feedback Close Sections Sections CBRNE - Vesicants, Mustard - Hd, Hn1-3, H Treatment Prehospital Care Patients contaminated with mustard agents endanger unprotected health care providers. Decontaminate patients exposed to mustard agents before transport and entry into medical (...) treatment facilities to prevent vapor accumulation. Providers attending contaminated patients should have protective masks, butyl rubber gloves (latex gloves are NOT adequate), and chemical protective overgarments. Unless carried out within 1-2 minutes, decontamination of victims exposed to mustard agents does not prevent subsequent blistering. After that brief window, decontamination still should be carried out as follows, to prevent secondary contamination: The first step is to cut away all

2014 eMedicine.com

173. Toxicity, Mushroom (Treatment)

and renal toxic syndromes. Gut decontamination, including whole-bowel irrigation, may be necessary for amatoxins. Beyond the first postprandial hour, orogastric lavage is not recommended, because of its questionable efficacy. Activated charcoal plays a much more important role in limiting absorption of most toxins and is indicated for all patients with amatoxin mushroom poisoning, regardless of the timing of presentation. When amatoxins are suspected, multiple doses of activated charcoal should (...) be administered repeatedly to interrupt enterohepatic circulation of these toxins. In general, children are more susceptible to volume depletion and mushroom toxicity (mushroom poisoning) than are healthy adults. Elderly patients are more susceptible to volume depletion than are healthy adults. Next: Supportive Measures Once a toxin is absorbed, it may potentially be neutralized in the following ways: Inhibition of tissue uptake of the toxin Inhibition of the metabolic pathways involved in the development

2014 eMedicine.com

174. Toxicity, Cyanide (Treatment)

A]) Removal of contaminated clothing and decontamination of the skin as required with soap and water Administration of high-flow oxygen, airway management, and ventilatory support as required Establishment of intravenous (IV) access Continuous cardiac monitoring Advanced cardiac life support (ACLS) measures as indicated for dysrhythmias Aggressive airway management with delivery of 100% oxygen can be lifesaving. (Although theoretically useless, supportive care with administration of oxygen alone has (...) Decontaminate the patient with removal of clothing/skin flushing and/or activated charcoal (1g/kg), as appropriate. Activated charcoal should be given after oral exposure in alert patients who are able to protect the airway or after endotracheal intubation in unconscious patients. In recent ingestions, activated charcoal may be preceded by gastric lavage. The gastric aspirate may cause secondary contamination and should be viewed as hazardous. Administer hydroxocobalamin or sodium thiosulfate and sodium

2014 eMedicine.com

175. Toxicity, Salicylate (Treatment)

aspiration during lavage or activated charcoal administration or in obtunded patients who cannot protect their own airway ABCs As with all significant overdoses the airway, breathing, and circulation (ABC) should be evaluated and stabilized as necessary. Dehydration and concomitant electrolyte abnormalities must be immediately corrected. GI tract decontamination Some authorities recommend performing gastric lavage in all symptomatic patients regardless of time of ingestion. Gastric lavage may (...) in children and 1-2 g/kg to a maximum of 100 g in adults. The minimum dose is 30 g. Use of cathartics is not routinely indicated with activated charcoal; however, many clinicians administer the first dose of activated charcoal with sorbitol. Sorbitol should not be used in young children. Repeat cathartic dosing generally should be avoided because of concern over resultant electrolyte imbalances. Repeated doses of charcoal may enhance salicylate elimination and may shorten the serum half-life. [ ] Although

2014 eMedicine.com

176. Toxicity, Arsenic (Treatment)

is of primary importance, and large amounts of crystalloid solutions may be required because of significant gastrointestinal (GI) losses (ie, vomiting, diarrhea). In the face of acute blood loss, the use of blood products may be critical in sustaining the life of the victim. The use of GI decontamination is controversial and may confuse the clinical picture. For acute arsenic ingestions, orogastric lavage is recommended if the patient presents rapidly or plain radiography indicates that arsenic is present (...) CCA-treated wood and their potential impacts on landfill leachate in a tropical country. Environ Technol . 2010 Apr 1. 31(4):381-94. . Luna AL, Acosta-Saavedra LC, Lopez-Carrillo L, Conde P, Vera E, De Vizcaya-Ruiz A, et al. Arsenic alters monocyte superoxide anion and nitric oxide production in environmentally exposed children. Toxicol Appl Pharmacol . 2010 Jun 1. 245(2):244-51. . Raghu KG, Yadav GK, Singh R, Prathapan A, Sharma S, Bhadauria S. Evaluation of adverse cardiac effects induced

2014 eMedicine.com

177. The Role of Antibiotics in Cutaneous Surgery (Overview)

arthroplasty. [ ] Importantly, note that even with a mupirocin decontamination protocol, the rates of colonization clearance are not 100%. A double-blinded, placebo-controlled trial performed by Harbarth et al demonstrated MRSA eradication at only 44% among the treatment group. [ ] An additional concern is the emergence of strains of S aureus resistant to some of the agents used for decolonization. Resistance to mupirocin has been seen, although rates remain relatively low. Low-level resistance (...) infection. Those at increased risk for MRSA infection include athletes, military personnel, prison inmates, men who have sex with men, intravenous drug users, homeless persons, children in daycare, Native Americans, and Pacific Islanders. Antibiotic coverage should include activity against MRSA. First-line treatment should be trimethoprim-sulfamethoxazole or a tetracycline antibiotic. Inducible lincosamide resistance is becoming more common; therefore, clindamycin should be considered a second-line

2014 eMedicine.com

178. Septic Shock (Overview)

. (See , , , and .) This article does not cover sepsis of the neonate or infant. Special consideration must be given to neonates, infants, and small children with regard to fluid resuscitation, appropriate antibiotic coverage, intravenous (IV) access, and vasopressor therapy. (See , , , , and .) Shock Classification, Terminology, and Staging Shock is identified in most patients by hypotension and inadequate organ perfusion, which may be caused by either low cardiac output or low systemic vascular

2014 eMedicine.com

179. Chemotherapy-Induced Oral Mucositis (Overview)

): Scores functional elements only See for more detail. Management The five main approaches to managing oral mucositis are as follows: Oral debridement (eg, brushing, toothettes); mucolytic agents, such as Alkalol, help dislodge dried secretions Oral decontamination, including antibacterial and antifungal rinses Topical and systemic pain management, such as 2% viscous lidocaine, magic mouthwash preparations, and topical morphine solution may be considered [ , ] Prophylaxis, such as ice-chip cryotherapy (...) % of patients who receive myeloablative conditioning regimens (chemotherapy with or without total body irradiation) in preparation for HCT develop oral mucositis; the incidence may be even higher in children. [ ] The incidence is also higher in patients who receive continuous infusion therapy for breast and colon cancer and in those who receive adjuvant therapy for head and neck tumors. However, in patients of the same age with similar diagnoses and treatment regimens and equivalent oral health status

2014 eMedicine.com

180. Dermatologic Aspects of Bioterrorism Agents (Overview)

officials. In 1996, an Ohio man was able to obtain bubonic plague cultures through the mail. In 1997, the Defense Against Weapons of Mass Destruction Act directed the Department of Defense to establish a domestic preparedness program to improve the ability of local, state, and federal agencies to respond to biological incidents. During 1998 and 1999, multiple hoaxes occurred involving the threatened release of anthrax in the United States that resulted in decontamination and antibiotic prophylaxis (...) and other fluoroquinolones are not recommended for use in children younger than 16-18 years because of a link to permanent arthropathy in adolescent animals and transient arthropathy in a small number of children. Balancing these small risks against the real risk of death and resistant strains of B anthracis , experts recommend that ciprofloxacin be given to pediatric patients for initial therapy or postexposure prophylaxis following an anthrax attack. In children, ciprofloxacin at 20-30 mg/kg/d IV in 2

2014 eMedicine.com

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