Handbook of Bioterrorism and Disaster Medicine

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Handbook of Bioterrorism and Disaster diagnosis, treatment, prognosis, prevention, tion is very important, as children too will Medicine. Robert E Antosia and John D and resources for additional information. be affected during a major disaster. While it Cahill, editors. New York: Springer. 2006. Chapter 4 covers the medical manage- would be easy to treat pediatric injury and Soft cover, illustrated, 492 pages, $89.95. ment of disaster-related injuries and disease. illness the same as we do with adults, the The first module in this chapter covers ba- differences in pediatric physiology and anat- The field of disaster medicine has grown sic emergency medicine such as the “ABC”s omy warrant specific pediatric-focused care, almost exponentially since September 11, (airway, breathing, circulation) and resusci- including age-specific vital signs. The mod- 2001, and in the aftermath of hurricanes tation for cardiopulmonary arrest, diagnosis ule “Evaluation and Management of Pedi- Katrina and Rita. Once the focus of emer- and management of shock, intravenous fluid atric Disaster Victims” gives a quick over- gency medicine and prehospital caregivers, therapy, and decontamination. Each subject view for those caregivers who have not taken this field of medicine is now expanding to is again addressed in a brief, concise format Pediatric Advanced Life Support. Important critical care physicians, nurses, respiratory that can be rapidly read. The module on concepts about the pediatric airway, breath- therapists, and hospital administrators. decontamination is well written and gives ing, and circulation are listed, followed by a Many states are now actively planning for the reader a quick overview of the decon- section on obtaining vascular access, which disasters and how best to prepare for them. tamination process. This section also focuses can be extremely challenging with the pe- The textbook, which is composed of 7 chap- on the importance of personal protection diatric population. The authors also men- ters, is well-written and easy to read. The equipment, which is vital to keep health care tion that normal saline or lactated ringers chapters are designed, as noted by the edi- workers from becoming patients themselves. are the choice of fluid for initial fluid re- tors, to be concise and well-supplemented The second module of this chapter fo- suscitation. Utilizing fluids with D5 [5% with Web-based resources. cuses on infectious diseases of disaster. Such dextrose solution] 0.25 normal saline or D5 The text of Chapter 1 begins with gen- pathogens as measles, malaria, tetanus, men- 0.5 normal saline should be reserved for eral concepts of disaster medicine, includ- ingitis, and tuberculosis are also formatted maintenance fluids, not bolus administra- ing topics such as epidemiology, triage, lo- in brief overviews. Each pathogen is illus- tion for treatment of shock. gistics, and “public health preparedness,” trated as to presentation, diagnosis, treat- A second module in this pediatric chap- which is a concept utilized by the United ment, prevention, and prognosis. Of inter- ter focuses on pediatric-specific disaster-re- States Federal Emergency Management est, there is no section on avian flu, which is lated considerations such as blunt trauma Agency; it describes the stages in both nat- currently on almost everyone’s “radar” as a from falls or flying debris. This module also ural and man-made disasters. The stages il- potential for a natural pandemic event. covers how the pediatric patient may differ lustrated are risk assessment, mitigation, re- The third module of this chapter focuses from adults in such injuries as abdominal, sponse, and recovery. It is important for on basic trauma management. Whether nat- cervical, and thoracic trauma. A third mod- health care workers involved in large-scale ural or man-made, the occurrence of some ule focuses on the utilization of pediatric form of trauma is a given and needs to be specialty teams in response to disasters that disasters to coordinate and communicate properly addressed to decrease overall mor- involve pediatric patients. This concept was with the governmental and nongovernmen- tality. This module first covers concepts of employed during hurricanes Katrina and tal agencies dealing with the disaster. This wound care and management. Rita, where specialty pediatric teams evac- chapter also includes a brief overview of This section emphasizes the importance uated sick and injured children in National intergovernmental and governmental orga- of obtaining a proper history of the injury Guard aircraft, institutional aircraft, and nizations that might participate in disaster and a thorough physical examination before ground ambulances. This allowed the spe- response. formulating a care plan for a trauma patient. cialized care to be instituted and maintained Chapter 2 covers natural disasters such A subsection of this module offers a brief during the disaster aftermath. This module as hurricanes, tornadoes, floods, and wild- overview of general and specific wound also contains 2 tables of pediatric equip- fires, and illustrates some of the potential management, which could be very helpful ment and medications that should be avail- natural disasters we face everyday. Each nat- for those who have limited experience treat- able to properly care for the sick or injured ural disaster section includes a brief over- ing such injuries. This module then covers pediatric patient. view and definition of the illustrated disas- specific regional trauma, such as abdomi- Chapter 6 addresses medical and human- ter, then the various facets, such as the types nal, thoracic, and neurologic trauma. Each itarian disasters, with concise modules on of likely injuries and needed treatments. regional trauma topic is broken down to a water, sanitation, and hygiene, shelter, ref- Chapter 3 covers bio-events and man- concise formatted overview and required ugees/displaced populations, and reproduc- made disasters, such as the epidemiology of care. This module concludes with coverage tive health issues. war and weapons of mass destruction, in- of such issues as blast, crush, and missile Chapter 7 focuses on education, health cluding anthrax, plague, hemorrhagic fever, injuries, and burn management. issues, and resources. The first module in and ricin. Each pathogen is covered in a Chapter 5 was of special interest to me in this chapter highlights emergency prepared- separate section, in a concise manner, in- that it was specific to pediatrics in disasters. ness and focuses on the operational aspects cluding discussion of clinical presentation, The inclusion of pediatrics as a separate sec- of implementing a response to an external

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disaster in a hospital setting. Issues such as ten in such a manner. Pharmacists may find apy book. Aspirin, which is available in oral the need for security, adequate communica- aspects of the book useful. doses of 81 mg and 325 mg, has recom- tion, utilizing a command center, surge ca- Chapter 1 covers acute resuscitation, in- mended doses of 75 mg to 162 mg in mul- pacity, and adequate supplies, such as food, cluding advanced cardiac life support and tiple tables for acute coronary syndrome. medicines and additional resources to be management of shock. The order of the chap- Chapters 4 through 7 are succinct. Pul- self-sufficient for 48–72 hours. Staffing ter is erratic; drugs for advanced cardiac life monary therapies incorporate bronchodila- needs are also addressed, including the use support (ACLS) are covered first, then shock tor treatment, pleurodesis, and pulmonary of volunteers who would probably show up and its treatment, and later the ACLS algo- embolism, although bronchodilator therapy to help staff in a disaster emergency. rithms. Table 1.1 would be accurate without in mechanically ventilated patients only Additional modules included in this chap- the anti-arrhythmic agents heading, in which makes it into the text underneath the table. ter include Joint Commission emergency drugs such as atropine, epinephrine, aden- There is no mention of therapies specifi- management standards, immunization osine, naloxone, and vasopressin are in- cally for chronic obstructive pulmonary dis- schedules/recommendations, health care cluded. The figure titles would be more ben- ease. In Chapter 5, renal, electrolyte, and worker exposure to blood and body fluids, eficial if placed at the top of the page, versus acid-base disturbances are discussed. For the and posttraumatic stress disorder. the bottom. Of note the ACLS guidelines treatment of hyperkalemia (Table 5.3), cal- Overall this text is a useful and well writ- listed are current with the 2005 update and cium gluconate and chloride have the same ten reference that addresses a wide variety are referenced accordingly. dose listed, although calcium chloride, mil- of topics, with a concise and logical ap- Chapter 2 encompasses anesthesia, seda- liliter for milliliter, has 3 times more cal- proach. In conclusion, this text is well writ- tion, analgesia, and—surprisingly for a drug cium than its gluconate salt—a fact noted ten for those who need a concise primer on therapy reference—tracheal intubation tech- by the authors as well. There is a repetitive bioterrorism and disaster medicine, but it niques. Combining bolus and continuous in- section on diuretics in this chapter (already may be a bit too condensed for those who fusions of paralytic agents (Tables 2.4 and covered in Chapter 3). are well versed in these topics. 2.5) could make for easier use. Also, Ta- Chapter 6 includes endocrine therapies, ble 2.4 appears to be missing some drug although glargine is omitted in the table of Steven E Sittig RRT-NPS FAARC information. There is no mention of halo- insulin preparations, yet an amylin analog Department of Anesthesia peridol in this chapter; instead it is located (pramlintide) has it own table. Gastrointes- Mayo Clinic in Chapter 9, on neurologic and psychiatric tinal topics such as gastrointestinal bleeds, Rochester, Minnesota therapies; however, neuroleptic malignant infectious diarrhea, and nutrition are high- syndrome is included. In other parts of the lighted in Chapter 7. book there are relevant notes underneath the Chapter 8 covers hematologic therapies, The author of this review reports no conflict of interest. tables. A disclaimer that patients must be ranging from blood components, to immune well-sedated prior to neuromuscular block- globulins, to anti-coagulant therapies, and The Handbook of Critical Care Drug ade should have been included with Ta- includes a table on heparin-induced throm- Therapy, 3rd edition. Gregory M Susla bles 2.4 and 2.5. This chapter also contains bocytopenia. Sections of this chapter are also PharmD, Anthony F Suffredini MD, Dor- several tables that cover both intravenous found elsewhere in the text, such as drug othea McAreavey MD, Michael A Solomon and oral analgesia, and equi-analgesic dos- information on heparin, direct thrombin in- MD, William D Hoffman MD, Paul Nyquist ing. hibitors, anti-platelet agents, and glycopro- MD, Frederick P Ognibene MD, James H Chapter 3 presents cardiovascular thera- tein IIb/IIIa, and are perhaps unnecessarily Shelhamer MD, Henry Masur MD. Amster- pies for unstable angina, heart failure, ar- included here. Four pages of this chapter dam: Wolters Kluwer/Lippincott Williams rhythmias, pulmonary arterial hypertension, are devoted to warfarin, a drug with limited & Wilkins. 2006. Soft cover, illustrated, 368 and vasoactive agents. This chapter in par- use in the intensive care setting. pages, $39.95. ticular is repetitive in terms of drugs and Chapter 9 is dedicated to cerebral mat- dosing. For instance, redundant information ters, including stroke, seizure, and psychi- Originally formulated because of the “com- on nitroprusside is included in 3 different atric disorders. plexity of critical care medicine,” The tables. Perhaps it would be “user-friendlier” Chapter 10 is a thorough section that cov- Handbook of Critical Care Drug Ther- to list the drug’s indications and uses in the ers antimicrobial agents, specific pathogens, apy, now in its third edition, aims to be an separate algorithms, but have one place and disease processes. Also covered are drug accessible and quick reference for drug ther- where all the drug information is located. dosages, prophylaxis regimens, and some apy, with an emphasis on content and or- The index (discussed below) could also be pediatric doses, which also appear elsewhere ganization. The book consists of 13 chap- made more helpful. As an example, nitro- in this text, although it is unclear why, as ters, well-formatted tables, 3 appendixes, a prusside is listed on 4 pages, even with one this book is ostensibly written with the adult table of contents, and an index. The chap- omission (on page 64). Also, the organiza- patient in mind. ters cover a mix of disease processes and tion of this dense chapter could be better. The book concludes with 3 small chap- therapies, and not all are on drug treatments; Table 3.1 discusses fibrinolytic therapies, ters that cover allergy, poisonings, and drug for instance, there is a table on colloids and but it refers the reader to Table 3.2 to read monitoring. The poisoning chapter could be crystalloids (Table 1.4) and one on blood the contraindications. Clinical trial doses, condensed by combining Tables 12.2 and components (Table 8). The title is slightly which may not be commercially available, 12.4, which would make for easier use. The misleading. This text is intended for physi- are recommended in some tables—a point drug monitoring chapter could be simpli- cians practicing at the bedside, and is writ- that should be noted, this being a drug ther- fied by moving the drugs that are included

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