Bioterrorism Attacks Involving Pediatric Patients: Preparedness and Early Recognition Are Critical

Bioterrorism Attacks Involving Pediatric Patients: Preparedness and Early Recognition Are Critical -

Bioterrorism Attacks Involving Pediatric Patients: Preparedness and Early Recognition Are Critical
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Publication Date: December 2018 (Volume 15, Number 12)

No CME for this activity


Joelle N. Simpson, MD, MPH, FAAP, FACEP
Assistant Professor of Pediatrics and Emergency Medicine, George Washington University School of Medicine & Health Sciences; Medical Director for Emergency Preparedness, Children’s National Health System, Washington, DC
Peer Reviewers
Solomon Behar, MD
Attending Physician, Pediatric Emergency Medicine, Long Beach Memorial/Miller Children’s Hospital and Children’s Hospital Los Angeles; Voluntary Faculty, Department of Pediatrics, UC Irvine School of Medicine, Long Beach, CA
Stuart A. Bradin, DO, FAAP, FACEP
Associate Professor of Pediatrics and Emergency Medicine, The University of Michigan; Attending Physician, Children's Emergency Services, C.S. Mott Children's Hospital, Ann Arbor, MI
Mark X. Cicero, MD
Associate Professor of Pediatrics; Director, Pediatric Disaster Preparedness, Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT

Due to their anatomic, physiologic, developmental, and behavioral characteristics, children are particularly vulnerable to bioterrorism agents. Symptoms associated with most bioterrorism agents can be difficult to differentiate from common childhood illnesses. It is extremely important that emergency clinicians are able to recognize unusual illness patterns that could distinguish a natural outbreak from a bioterrorism attack. Resources available through government agencies and leading pediatric organizations can aid in diagnosis and treatment. This issue reviews the highest-risk bioterrorism agents and provides guidance for diagnosing and managing pediatric patients who have been exposed to these agents.

Excerpt From This Issue

During a busy flu season, a 5-year-old previously healthy boy presents to the ED after 2 days of fever, cough, fatigue, and myalgias. He is given an antipyretic in triage. The patient is up-to-date on his vaccine schedule and has had an influenza vaccine this season. He has an episode of nonbilious emesis while waiting to be seen. In the process of being reassessed by the triage nurse, the patient is noted to have significant dyspnea and an oxygen saturation of 89%. The boy’s vital signs are: temperature, 35.6°C (96.0°F); heart rate, 178 beats/min; respiratory rate, 44 breaths/min; and blood pressure, 70/30 mm Hg. The child becomes pale and diaphoretic. A sepsis alert is triggered, and the patient is taken back to a room. On further questioning, the mother reports no notable sick contacts; she also states that the child has not had nasal congestion or a runny nose. You note a pale, listless child and auscultate diffuse crackles at the lower lung bases. You suspect this child will need critical-level care and, given the busy influenza season, you call your critical care colleague who exclaims, “Another one—this is the seventh patient with a similar presentation in 24 hours! What is going on?”

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