CAUSE OF INTERNAL CONTAMINATION TREATMENT Tritium Massive hydration SEE radionuclide handbook (tritium) Strontium Calcium salts SEE radionuclide handbook (strontium) Radioactive isotopes of iodine Potassium iodide: administer as early as possible. The aim is to prevent the build-up of radioactive iodine in the thyroid, and the earlier the treatment the more effective it is. SEE SHEET 39 + radionuclide handbook (iodine) Actinides (plutonium) and certain metals Ca-DTPA, reference chelating agent, administered in 2 possible ways: • by slow IV route : one half vial, i.e. 0.5 g without exceeding 1 g/day; • by nebulisation. SEE SHEET 39 + radionuclide handbook (plutonium) Principal dose reduction mechanisms INCREASE THE EXCRETION OF THE RADIONUCLIDE REDUCE GASTRO-INTESTINAL OR PULMONARY ABSORPTION Increase by isotopic dilution (e.g. tritium diluted by water), mobilisation (e.g. strontium mobilised by stable calcium), blocking of storage (e.g. radioactive iodine) or chelation (e.g. with plutonium). CAUSE OF INTERNAL CONTAMINATION TREATMENT Radioactive caesium Indium Thallium Prussian Blue, which chelates caesium, forming a compound that is not absorbed in the digestive tract. It thus reduces the absorption of caesium and fosters its elimination in the stools. • Oral route: 3 g of Prussian Blue for adults SEE SHEET 39 + radionuclide handbook (caesium, indium, thallium) This technique uses the chelating power of Ca-DTPA with respect to actinides and certain metals. 1. Wash the contaminated wounds for draining, using vials of injectable Ca-DTPA. 2. Cover the wound with an absorbent dressing containing 3 to 4 g of Ca‑DTPA (injectable vials – 25% solution). SEE SHEET 39 Treatment of wounds contaminated by actinides and certain metals IF NOT TREATED IN VAA If contaminated wounds have not been treated in the Victim Assembly Area (VAA), they are treated in the 1st line healthcare facility. i ACTION TO TAKE ON THE SITE OF THE EVENT In the VAA: treating internal contamination and contaminated wounds 27 SHEET Particular attention must be paid to children (and, by extension, to pregnant and breast-feeding women) because they are the most radiosensitive population group. 85 Sr Strontium 89 Sr Strontium 137 Cs Caesium 115m In Indium 201 Tl Thallium 90 Sr Strontium 240 Pu Plutonium T or 3H Tritium 132 I Iodine 131 I Iodine 125 I Iodine 123 I Iodine MEDICAL RESPONSE IN NUCLEAR OR RADIOLOGICAL EMERGENCY 83
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