Krivoy Amir, Finkelstein Arseny, Rotman Eran, Layish Ido, Tashma Zeev, Hoffman Azik, Schein Ophir, Yehezkelli Yoav, Dushnitsky Tsvika, Eisenkraft Arik
Harefuah. 2007 Mar;146(3):228-34, 244.
Although the use of cyanides as warfare agents has not been documented since the Iran-Iraq war in the 1980s, there are rising fears of cyanide being used by terrorists. An Al-Qaeda terror plot to use cyanide gas in the London Underground was foiled in 2002. The threat of similar events becomes more imminent in light of the terror attacks in our country and worldwide, accompanied by statements and threats by fundamentalist leaders to employ chemical weapons. Therefore, mass-intoxication with cyanides is not merely a hypothetical scenario. The treatment of cyanide poisoning is under constant evaluation and there is no international consensus on the subject. The medical treatment of victims at the scene and in hospitals should be rapid and efficient. Current treatment dictates establishing an intravenous line and a slow rate of administration of antidotes. Both demands are not feasible in this specific mass casualty event. The clinical signs of cyanide poisoning are complex, variable and not necessarily obvious for the medical team. There is great interest in reconsidering the existing treatment protocols for cyanide intoxication in light of current research. This review describes the mechanisms of cyanide toxicity, clinical signs of exposure, and current treatment protocols in use worldwide. On the basis of this evidence we suggest a medical treatment protocol for a mass casualty event caused by cyanide.
尽管自20世纪80年代的两伊战争以来，尚无氰化物被用作战争武器的记录，但人们越来越担心恐怖分子会使用氰化物。2002年，基地组织在伦敦地铁使用氰化气体的恐怖阴谋被挫败。鉴于我国和全球范围内的恐怖袭击，以及原教旨主义领导人使用化学武器的声明和威胁，类似事件的威胁变得更加迫在眉睫。因此，氰化物大规模中毒并非仅仅是一种假设情况。氰化物中毒的治疗一直在评估中，对此问题尚无国际共识。在现场和医院对受害者的医疗救治应迅速且有效。目前的治疗方法要求建立静脉通路并缓慢注射解毒剂。在这种特定的大规模伤亡事件中，这两个要求都不可行。氰化物中毒的临床症状复杂、多变，对医疗团队来说不一定明显。鉴于当前的研究，人们对重新考虑现有的氰化物中毒治疗方案非常感兴趣。本综述描述了氰化物毒性的机制、接触的临床症状以及全球范围内目前使用的治疗方案。基于这些证据，我们提出了针对氰化物导致的大规模伤亡事件的医疗救治方案。
