Bioterrorism Attacks Involving Pediatric Patients: Preparedness and Early Recognition Are Critical (Pharmacology CME) - $49.00
Publication Date: December 2018 (Volume 15, Number 12)
CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 12/1/2021
Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease CME and 1.5 Pharmacology CME credits, subject to your state and institutional approval.
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
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?”
Dr. Simpson - 03/22/2019 I found this a very succinct and well-organized review that focused on major agents to be concerned about. Other reviews I have read about potential bioterrorism agents were very much "inch deep, mile wide", with too many substances and agents reviewed and too overwhelming to feel that you would remember the salient points. With this review, I feel that I picked up some good pearls and useful recommendations for where to find quick information in a possible emergent situation.
Dr. Simpson - 03/21/2019 Very comprehensive review, well-organized, extremely helpful and adaptable information.
Dr. Simpson - 03/19/2019 Very well written article subjective patient should be in the back of every emergency medicine physician's differential diagnosis which can be easily overlook and busy ER.
Dr. Simpson - 03/16/2019 I will be more aware of the possibility of a bioterrorism case in a sick child as the result of this activity.
Dr. Simpson - 03/13/2019 Certainly increased awareness consideration of bioterrorism with the certain presentation of illness and in light of certain historical considerations.
Dr. Simpson - 03/08/2019 After reading this, I’ll consider bioterrorism when confronted with patients with fever and viral type symptoms that seem more severe in presentation, or has other uncommon characteristics that differ from the usual suspected, common childhood illnesses.
Dr. Simpson - 03/06/2019 I previously felt overwhelmed and unsure about my role in identifying bioterrorism but this article outlined basic steps for identifying possible bioterrorism cases and provided next steps for action.
Dr. Simpson - 03/04/2019 I'll consider these agents if unusual numbers or virulence ....as noted in the article, presentation is generally nonspecific, so challenging to sort out for the first several cases.
Dr. Simpson - 03/01/2019 Will have greater awareness of bioterrorism agents and watch for case clusters indicating a possible bioterrorism event.
Dr. Simpson - 02/28/2019 This article heightens my awareness of Bioterrorism, its presentation and the involvement of the CDC and the health department for guidance. Discussed the importance of isolation and protective equipment.
Dr. Simpson - 02/22/2019 I am now better prepared for possible bioterrorism events.
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