Pediatric emergency medicine trisk 1986 1986
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exposures, whereas destruction of the containers and dispersal of their contents
could also lead to contamination. A “dud” nuclear weapon that does not undergo
a nuclear fission reaction would still disperse radioactive materials by the
associated conventional explosion, leading to contamination in addition to effects
from the conventional explosion itself. A nuclear weapon effectively detonated
by a terrorist group might be relatively small scale but still capable of widespread
damage, including thermal and blast effects from the denotation along with
contamination and exposure of affected persons.
Triage Considerations
Triage and management should focus on securing ABCs (airway, breathing,
circulation) and monitoring vital signs. Major trauma, burns, and respiratory
injury should be treated first. No survivable radiation injury requires direct
immediate lifesaving treatment; hence, medical staff should focus their attention
on the treatment of non–radiation-related, life-threatening conditions. Once
stabilized, the radiation-related injuries can be addressed. In addition to routine
trauma labs, it is recommended that a CBC be obtained to assess lymphocyte
count.
Because there is no immediate treatment of radiation exposure, the problem of
radioactive contamination should be addressed first. In most circumstances, a
Geiger counter can be used to determine the presence of contamination. The
probability of contamination can be assessed by obtaining an accurate description
of the accident and the likely radiation source. If the patient is a radiation worker,
finding his or her radiation badge and performing a “reenactment” of the accident
may be critical for dose estimation.
Management and Diagnostic Studies
Internal Contamination
Treatment of internal contamination is most effective if initiated promptly. The
requirement for prompt treatment is a dilemma for the physician as it is difficult
to determine if internal contamination is present until the external contamination
has been removed. Moistened cotton Q-tips can be used to perform nasal swabs.
If these show radioactivity, inhalation of radioactive materials is possible. The
nature of the accident may provide clues to the possibility of internal
contamination (e.g., a fire with smoke leading to the inhalation of radioactive
particles). The most effective treatment requires knowledge of the radionuclide
involved and its chemical form. This information is usually not immediately
available. Fortunately, there are simple general treatment measures that can be
