Yamamoto Loren G
From the Department of Pediatrics, Professor of Pediatrics, University of Hawaii John A. Burns School of Medicine, Emergency Department, Emergency Medicine Director and Vice-Chief of Staff, Kapiolani Medical Center For Women & Children, Honolulu, HI.
Pediatr Emerg Care. 2013 Sep;29(9):1016-26; quiz 1027-29. doi: 10.1097/PEC.0b013e3182a380b8.
High-energy ionizing radiation is harmful. Low-level exposure sources include background, occupational, and medical diagnostics. Radiation disaster incidents include radioactive substance accidents and nuclear power plant accidents. Terrorism and international conflict could trigger intentional radiation disasters that include radiation dispersion devices (RDD) (a radioactive dirty bomb), deliberate exposure to industrial radioactive substances, nuclear power plant sabotage, and nuclear weapon detonation. Nuclear fissioning events such as nuclear power plant incidents and nuclear weapon detonation release radioactive fallout that include radioactive iodine 131, cesium 137, strontium 90, uranium, plutonium, and many other radioactive isotopes. An RDD dirty bomb is likely to spread only one radioactive substance, with the most likely substance being cesium 137. Cobalt 60 and strontium 90 are other RDD dirty bomb possibilities. In a radiation disaster, stable patients should be decontaminated to minimize further radiation exposure. Potassium iodide (KI) is useful for iodine 131 exposure. Prussian blue (ferric hexacyanoferrate) enhances the fecal excretion of cesium via ion exchange. Ca-DTPA (diethylenetriaminepentaacetic acid) and Zn-DTPA form stable ionic complexes with plutonium, americium, and curium, which are excreted in the urine. Amifostine enhances chemical and enzymatic repair of damaged DNA. Acute radiation sickness ranges in severity from mild to lethal, which can be assessed by the nausea/vomiting onset/duration, complete blood cell count findings, and neurologic symptoms.
高能电离辐射具有危害性。低剂量暴露源包括天然本底辐射、职业辐射和医学诊断辐射。辐射灾害事件包括放射性物质事故和核电站事故。恐怖主义和国际冲突可能引发蓄意辐射灾害，其中包括辐射扩散装置（RDD）（放射性脏弹）、故意暴露于工业放射性物质、破坏核电站以及核武器爆炸。诸如核电站事故和核武器爆炸等核裂变事件会释放放射性沉降物，其中包括放射性碘131、铯137、锶90、铀、钚以及许多其他放射性同位素。一枚RDD脏弹可能只会散布一种放射性物质，最有可能的物质是铯137。钴60和锶90也是RDD脏弹可能使用的放射性物质。在辐射灾害中，病情稳定的患者应进行去污处理以尽量减少进一步的辐射暴露。碘化钾（KI）对碘131暴露有效。普鲁士蓝（六氰合铁酸铁）通过离子交换促进铯的粪便排泄。钙促排灵（二乙三胺五乙酸）和锌促排灵与钚、镅和锔形成稳定的离子络合物，这些络合物通过尿液排出。氨磷汀可增强受损DNA的化学和酶促修复。急性放射病的严重程度从轻到重不等，可通过恶心/呕吐的发作/持续时间、全血细胞计数结果以及神经症状来评估。
