Autoinjectors pediatric

FIGURE 61.6. The Atropen pediatric autoinjectors. Dose sizes 0.25 mg - infant, 0.5 mg - child (7-18 kg), 1 mg - child (18 1 kg), 2 mg - adolescent/adults. Photograph reproduced with permission from Meridian Medical Technologies . 

FIGURE 61.7. Technique for using Atropen pediatric autoinjector. 

Nerve agent exposures must be handled quickly and efficiently. When children are exposed, it is important to remember that antidote dosing will be determined by the patient s weight and the severity of exposure. Progress has been made to provide pediatric-specific autoinjectors however, since 2-PAM Cl is not yet available in a pediatric autoinjector form, it is possible to carefiilly use adult autoinjectors to manage pediatric patients. 

In mass casualty situations, intravenous antidotes may not be available. In that case, the intramuscular administration is acceptable. Most Emergency Medical Systems in the United States now stock military Autoinjector units containing atropine and pralidoxime, although kits with pediatric doses may not be available. However, in critical situations, children older than 2 or 3 years of age weighing at least 13 kg might benefit from 2 mg of atropine and 600 mg pralidoxime administered intramuscularly with auto-injectors (7). Experience with the accidental atropine auto-injection in 240 Israeli children unexposed to nerve agents revealed that... 

In a recent evaluation of pediatric poisoning from trimedoxime and atropine-containing autoinjectors in Israel, no serious side effects were associated with exposure to the oxime. Twenty two children who inadvertently injected more than the recommended, age-adjusted dose (1 mg atropine and 40 mg trimedoxime for children 3-8 years or double that dose for persons > 8 years) did not develop severe adverse reactions, nor did they require medical intervention (Kozer et al, 2005). HI 6 dichloride was tested in a double-blind, placebo controlled, ascending dose-tolerance study (HI 6 + 2 mg atropine sulfate) in 24 healthy male volunteers (Clement and Erhardt, 1994). Doses from 62.5 up to 500 mg were well tolerated by the subjects without serious complaints. There were no clinically significant changes in heart rate or ECG, respiration or blood pressure or visual and mental acuity... 

Henretig, RM., Mechem, C., Jew, R., 2002. Potential use of autoinjector-packaged antidotes for treatment of pediatric nerve agent toxicity. Ann. Emerg. Med. 

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