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.
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.
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?”