Dirty bomb: Difference between revisions

(Text replacement - "==Diagnosis==" to "==Evaluation==")
 
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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==
*can cause exposure to I-131
*See [[Blast injury]] and [[Acute radiation syndrome]]
*administration of potassium iodide (KI) can significantly reduce thyroid I-131 uptake, which can later causes thyroid cancer
*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


{| width="339" border="1"
==Differential Diagnosis==
| '''Time to KI Dose'''<br />
{{MCI types}}
| '''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>
==Evaluation==
*Determined by injuries
*If [[Acute radiation syndrome]] suspected, establishing baseline with CBC and CMP is appropriate.


==Diagnosis==
==Management==
*Priority is treatment of blast injuries and burns
*ED treatment of [[Acute radiation syndrome]] is primarily supportive


Insert
==Disposition==
 
*Most patients require admission.
==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).
 
#Under 40 years old
##potassium iodide (KI)
##immediate and Qday x 7-14 days
#Over 40 years old
##no KI treatment
 
*contraindication = iodine allergy
*potassium iodate (KIO3) can also be used (more GI irritation)
 
==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.