Disaster preparedness, pediatric considerations in primary blast injury, chemical, and biological terrorism

Table 2 Management of chemical agents

Agent	Pediatric dosing	Notes
Nerve agents	Atropine 0.05 mg/kg iv or im q 2-5 min (max 5 mg) Pralidoxime 25 mg/kg iv or im q 1 h (max 1 g iv or 2 g im) Benzodiazepines: Midazolam im 0.2 mg/kg (max 10 mg) (1st choice) Lorazepam iv/im 0.1 mg/kg (max 4 mg) Diazepam iv 0.3 mg/kg (max 10 mg)	Atropine should be repeated for persistent symptoms
Cyanide	Hydroxocobalamin 70 mg/kg (max 5 g) or sodium nitrate; 0.33mL/kg iv (max 10 mL) followed by sodium thiosulfate (25%) 1.65 mL/kg iv (max 50 mL)	Hydroxocobalamin may be repeated × 1 if needed