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Abstract PD-012: EVIDENCE-BASED GUIDELINES FOR THE MANAGEMENT OF CHILDREN FOLLOWING NERVE AGENT EXPOSURE

Vepers, S.1; Beattie, T.1; Midgley, P.1

Pediatric Critical Care Medicine: June 2018 - Volume 19 - Issue 6S - p 32
doi: 10.1097/01.pcc.0000537414.54214.37
Poster Discussion Abstracts
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1The University of Edinburgh, Clinical Sciences, Oxford, United Kingdom

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Aims & Objectives:

Recent observations showing increasing terror attacks, including chemical incidents such as those in Syria in 2013 and 2017, have shown the importance of being prepared. Children are often left out in such preparations so this review aims to provide a management guideline for children exposed to nerve agents (NA).

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Methods

Evidence was obtained by literature review via OvidSP and Pubmed. Search terms included: “organophosphate poisoning” “nerve agent poisoning” “child$” “paediatric” “pediatric”. Inclusion criteria: up to 21/06/2017. Exclusion criteria: non-English language papers/abstracts. Analysis of papers used PRISMA guidelines.

Primary outcome measures: identify treatments and dosing schedules for safe use in children after NA exposure. Secondary measures: identify symptoms in children.

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Results

Only 3 out of 160 documents found during the PRISMA process specifically addressed NA incidents involving and treating children.

A guideline was developed using principles of triage and treatments found in agreed use: decontamination, atropine, oximes and adjuncts including benzodiazepines and magnesium sulphate. Other novel therapies such as gacyclidine were also identified; however research is insufficient to include them in treatment guidelines at this time.

Symptoms identified are shown in table 1.

Other problems identified included needing to treat large numbers over short time periods and acceptable delivery methods which address this.

Table

Table

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Conclusions

Very few high level evidence papers exist covering NA exposure in children and specific treatment regimes for children are scarce. A treatment guideline is proposed to fill this gap, though other issues were also identified and further research is needed so that children are not forgotten in times of crisis.

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies