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Treatment of hydrocarbon pneumonitis consists of airway control if there is
mental status depression and mechanical ventilation if ventilation is impaired.
Acute respiratory distress syndrome may ensue, and heroic measures such as
extracorporeal membrane oxygenation have been successfully employed.
Antibiotics should not be used prophylactically but should be reserved for
specific infections if they develop. The use of corticosteroids is associated with
increased morbidity and is not recommended. In the event of hypotension or
bronchospasm, epinephrine should be avoided if possible because hydrocarbons
are known to cause ventricular irritability and predispose to fibrillation, an effect
that is exacerbated by catecholamines.
Lead
CLINICAL PEARLS
No safe blood lead level in children has been identified.
The most important aspect of lead poisoning treatment is removal from
further lead exposure.
Lead encephalopathy is now rare in the United States, but clinicians
must maintain a high index of suspicion in children with lead exposure
and GI and neurologic symptoms.
Patients with lead encephalopathy should be treated with dimercaprol
(BAL) IM followed by IV calcium disodium EDTA, in addition to
aggressive supportive care.
Current Evidence. Although lead poisoning is usually the result of residential lead
paint in children or of occupational exposure in adults, patients with lead
poisoning may come to the ED with varied complaints of recent onset that often
mimic diverse acute illnesses. Fortunately, severe lead encephalopathy is now
rare, attributable in large part to widespread screening programs and early
recognition of asymptomatic or mildly ill children.
The major source of excess lead absorption in children is lead-based paint,
widely used in home interiors through the 1950s. In addition to the ingestion of
macroscopic-sized chips of paint, children are often exposed to house dust with a
high lead content that results from finely crumbled paint particles, which gets on

their hands and toys. Repetitive mouthing can lead to increased lead exposure
even in the absence of observable pica. Home renovation often includes sanding,
stripping, and burning of lead-based paint from woodwork in houses and is been