Dirty bomb: Difference between revisions

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==Background==
==Background==
*Also known as "Radiological Dispersal Device"<ref name="Rosoff">Rosoff H, von Winterfeldt D. A risk and economic analysis of dirty bomb attacks on the ports of Los Angeles and Long Beach. Risk Anal. 2007 Jun;27(3):533-46.</ref>
*Consists of radioactive material packaged into non-nuclear (conventional) bomb<ref name="Rosoff" />
**No nuclear fusion/fission occurs
**Detonation causes injuries from conventional explosion and also spreads radioactive material, causing radiation injuries and cancer
**Radioactive material spread locally via blast, and carried more distantly via aerosolized or particulate "plumes"
**Multiple radioisotopes from various sources (e.g. nuclear fuel waste, medical radiography, etc) could be employed
*Most injuries and deaths will be caused by blast injuries, not radiation injury<ref name="Chin">Chin FK. Scenario of a dirty bomb in an urban environment and acute management of radiation poisoning and injuries. Singapore Med J. 2007 Oct;48(10):950-7.</ref>
*Triage of patients by radiation dose received is important and should be coordinated with disaster response officials.


-is a non-nuclear normal bomb cased in radioactive material
==Clinical Features==
*See [[Blast injury]] and [[Acute radiation syndrome]]


-can cause exposure to I-131
==Differential Diagnosis==
{{MCI types}}


-administration of potassium iodide (KI) can significantly reduce thyroid I-131 uptake, which can later causes thyroid cancer
==Evaluation==
*Determined by injuries
*If [[Acute radiation syndrome]] suspected, establishing baseline with CBC and CMP is appropriate.


-for persons older than 40 years of age, the risk for radiation-induced thyroid cancer is extremely low, while the potential side effects of prophylaxis due to preexisting thyroid disease tend to increase
==Management==
*Priority is treatment of blast injuries and burns
*ED treatment of [[Acute radiation syndrome]] is primarily supportive


{| width="339"
==Disposition==
| '''Time to KI Dose'''<br />
*Most patients require admission.
| '''Reduction in Radioactive Uptake'''<br />
|-
| <2hrs<br />
| 90%<br />
|-
| 3hrs<br />
| 50%<br />
|-
| 4hrs<br />
| 10%<br />
|-
| >4hrs<br />
| little protection*<br />
|}
 
<nowiki>*unless the exposure to I-131 continues</nowiki>
 
==Diagnosis==
 
Insert
 
==Work-Up==
 
Insert
 
==DDx==
 
Insert</div>
 
==Treatment==
 
Treatment with stable iodine when the committed dose equivalent to the adult thyroid is expected to exceed 250 milliSieverts (mSv), the equivalent of 25 rem (FDA 2001).
 
1) Under 40 years old
 
-->potassium iodide (KI)
 
-immediate and Qday x 7-14 days
 
2) Over 40 years old
 
-->no KI treatment
 
<div>-contraindication = iodine allergy</div><div>-potassium iodate (KIO3) can also be used (more GI irritation)</div>
 
 
 
==Disposition>==
Insert


==See Also==
==See Also==
*[[Disaster medicine]]
*[[Acute radiation syndrome]]
*[[Radiation exposure (disaster)]]


Insert
==References==
 
<references/>
==Source==
 
Adapted from KajiQuestions
 


[[Category:Environ]]
[[Category:Environmental]]
[[Category:EMS]]

Latest revision as of 20:42, 26 July 2016

Background

  • Also known as "Radiological Dispersal Device"[1]
  • Consists of radioactive material packaged into non-nuclear (conventional) bomb[1]
    • No nuclear fusion/fission occurs
    • Detonation causes injuries from conventional explosion and also spreads radioactive material, causing radiation injuries and cancer
    • Radioactive material spread locally via blast, and carried more distantly via aerosolized or particulate "plumes"
    • Multiple radioisotopes from various sources (e.g. nuclear fuel waste, medical radiography, etc) could be employed
  • Most injuries and deaths will be caused by blast injuries, not radiation injury[2]
  • Triage of patients by radiation dose received is important and should be coordinated with disaster response officials.

Clinical Features

Differential Diagnosis

Mass casualty incident

Evaluation

Management

Disposition

  • Most patients require admission.

See Also

References

  1. 1.0 1.1 Rosoff H, von Winterfeldt D. A risk and economic analysis of dirty bomb attacks on the ports of Los Angeles and Long Beach. Risk Anal. 2007 Jun;27(3):533-46.
  2. Chin FK. Scenario of a dirty bomb in an urban environment and acute management of radiation poisoning and injuries. Singapore Med J. 2007 Oct;48(10):950-7.