Difference between revisions of "Radiation exposure (disaster)"

 
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== Background ==
+
==Background==
 +
*“Ionizing” radiation is electromagnetic or particulate which can create charged particles or ions
 +
*"Non-ionizing radiation" ( e.g., light, microwaves, and radiowaves) does not have sufficient energy to eject an electron from another atom
 +
*Ionization of biologically important molecules, e.g., DNA, can cause cellular death
 +
*Ionizing radiation at higher doses can cause damage to actively dividing and undifferentiated cell types, e.g., stem and progenitor cells in the bone marrow, gastrointestinal system, and skin
  
*potentially easy to deal with since lots of people deal with radiation daily- univ, hosp, military
+
===Radiological and Nuclear Scenarios of Concerns===
*easy to detect with geiger counters
+
*Radiological exposure devices
*immediate effects well known and easy to assess with blood counts
+
*Radiological dispersal devices
 +
*Nuclear power plant incidents/accidents
 +
*Improvised nuclear devices
  
=== Radiological and Nuclear Scenarios of Concerns<br> ===
+
====Radiological Exposure Devices (RED)====
 +
*A RED is a device that can cause exposure to ionizing radiation without the knowledge of the person being exposed
 +
*Surreptitious placement of a RED could delay discovery and notification of the healthcare community
 +
*Injury is based on the radiation dose received, whether accidental or intentional in nature
 +
*A concealed RED scenario could result in serious injuries
  
*Nuclear Power Plant Incidents/Accidents<br>
+
====Radiological Dispersal Devices (RDD)====
*Radiological Exposure Devices
+
*Any device used to spread radioactive material; more commonly thought of as an explosive device or “dirty bomb"
*Radiological Dispersal Devices
+
*Do ''not'' necessarily need to explode in order to spread radiological material into the environment
*Improvised Nuclear Devices
+
**Non-explosive RDD could cause environmental contamination that could lead to human contamination (e.g. use in facility ventilation systems, fumigation systems, etc.)
 +
*Explosion of an improvised explosive devices (IED) with radioactive material could cause additional injury, internal contamination, and panic
 +
*Persons near the epicenter of an explosion of a dirty bomb will sustain physical trauma, thermal burns, and embedded foreign bodies including radioactive shrapnel. 
 +
*Amount of physical damage from RDD would depend on amount and type of explosives used; additional radiological consequences would depend on source and physical properties as well as explosive device
 +
*Removal of foreign bodies would require healthcare providers wear PPE and have access to radiation monitoring equiment (e.g. ring dosimeters)
 +
*Management of internal contamination via inhalation or wounds might be required for some patients
  
==== Radiological Exposure Devices ====
+
====Nuclear Power Plant (NPP) Incident/Accident====
 +
*The Fukushima Japan nuclear power plant disaster in March of 2011 was highly unusual and the first time that such a serious situation at a nuclear power plant resulted from an environmental disaster.
 +
*Nuclear power plants use the energy created by the fissioning of atomic nuclei ("splitting" of the atom) to generate electricity. *Heat generated during fission process converts water to steam, which then is used to drive electricity-generating turbines
 +
*Loss of power to coolant pumps can allow reactor core to overheat, which can then cause the radioactive core to "melt-down".
  
*minimally radioactive sources maybe used to create fear and panic- ex- exempt low level radioisotopes from nuc medicine, research. no immediate effects and probability of long term effects low
+
====Nuclear Device Detonation====
*highly radioactive substances- cobalt, cesium, iridium- used in radiotherapy and radiographic machines have penetrating radiation so easy to detect at check points
+
*3 forms of energy released by nuclear detonation<ref name="SNSRWG">Waselenko JK, MacVittie TJ, Blakely WF, et al. Medical management of the acute radiation syndrome: recommendations of the Strategic National Stockpile Radiation Working Group. Ann Intern Med. 2004 Jun 15;140(12):1037-51.</ref>
*if souce is metallic- there will be radiation exposure but no contamination. if powder get both exposure and contamination
+
**Heat (35% of total)
*if handle it, will get local skin injury and are risk for acute radiation syndrome
+
**Shock or bomb blast (50%)
 +
**Radiation (15%)
 +
*The detonation of any kind or size of nuclear weapon would be expected to cause massive physical damage to a community and untold psychological devastation to its population. In 2009, the National Security Staff released the first edition of Planning Guidance for the Response to a Nuclear Detonation10  In this document, planners categorized the devastation, types of physical damage, and types of human injuries based upon distance from the detonation epicenter in zones. The second edition of this document, released in June 2010, updated recommendations and guidance based on intensive modeling efforts to try to further quantify the effects of a nuclear detonation in an urban American city. Part of the updates to the guidance includes further refinement of the proposed damage zones. The document’s authors called the area closest to the epicenter the Severe Damage (SD) zone; the adjacent area the Moderate Damage (MD) zone; and the affected area furthest away from the epicenter, the Light Damage (LD) zone. In addition, a dangerous fallout (DF) radiation zone, which is determined by the scattering of radiological material, is also defined3. The presumed “safe” and “dangerous” distances away from the epicenter vary from scenario to scenario in modeling efforts and would be made after-the-fact by the incident commander based upon types of damage found on the ground.  Zone determinations would depend upon:
 +
*The yield of the weapon
 +
*Whether the detonation was  at a height or at ground level, and
 +
*The topographical features of the terrain and its structures.
  
==== Radiological Dispersal Devices ====
+
==Basic Principles==
 +
===Physical Properties===
 +
*Radiation Types
 +
**Gamma and xrays - deep penetration
 +
**Alpha - hazard only if ingested/ inoculated since penetration only ~0.1mm
 +
**Beta/electrons - penetrate only a few centimeters
 +
*Dose
 +
**Rads - dose absorbed by specific tissue.
 +
**Gray (Gy) - international unit for absorbed dose. (1 Gy = 100 rads)
 +
**REM - "Effective Dose" (100 rem = 1 sievert = 1 Gy)
 +
*Principles of exposure
 +
**Different radioactive particles have diff effects at same absorbed dose- so use effective dose for comparison
 +
**Effect of radiation based on time of exp, distance and shielding
 +
**Dose decreases rapidly with square of distance and decreases on 1/9th if triple distance
 +
**Lead is an effective shield
 +
*Radiation decays with time
 +
**Iodine isotopes are short lived
 +
**Cesium, stontium, cobalt are longer-lived
 +
**Rate of decay also effects dose of exposure and may effect management decisions
  
*is greater concern since will be able to spread to more people and assoc traumatic injuries- will also cause additional fear, panic
+
===Biological Principles===
*extent of dispersal depends on physical form of source- solid or powder, explosive type, atmospheric conditions
+
*Some cells may die but if cells role not critical for survival, may not see effect
*health hazard only a few city blocks- goal of response to monitor and contain.
+
*Rapidly dividing cells (e.g. GI and bone marrow) are most vulnerable
 +
*Dose ~1Gy, cells survive but get cancer later
 +
*Radiation-induced cancer dose related
 +
*[[Leukemia]] within 2 yrs, solid tumors 5-10 or more yrs
 +
*Beta rays from fallout only burn exposed skin
  
==== Nuclear Power Plant Incident/Accident ====
+
==Clinical Features==
 +
*Presentation dependant on nature of exposure
 +
**See [[acute radiation syndrome]], [[blast injuries]]
 +
**May be asymptomatic
 +
*Radiation burn like thermal [[burn]] but signs can occur after a few days, vascular insufficiency after several months and causing necrosis of previously healed skin
  
*reactor if steel vessel in concrete building. if damaged, is designed to slow down stop reaction
+
==Differential Diagnosis==
*if cooling system damaged, may get some radiation leak- radioactive iodine and noble gases
+
{{MCI types}}
*gas escape for reactor core will have immediate nearby health effects and rad iodine can have thyroid CA in kids long term at great diistances
 
*many nuclear engineering dept at univ have small reactors and are easy targets
 
*spent radioactive fuel rods stored in less secure places but hard to expose large population to this solid source
 
  
==== Nuclear Device Detonation ====
+
==Evaluation==
 +
* Evaluate and stabilize any life threatening physical injuries (ABC's)
 +
* Decontaminate after stabilized
 +
**Check for external contamination
 +
***document location, dose rate and/or count measurements initial and after decontamination, and description of decontamination methods/agents used
 +
**Check for internal contamination
 +
***swab both nostrils
 +
***24-hour stool and 24-hour urine samples
 +
***Identify radionuclide (chemical form), solubility and particle character
 +
***Document suspected route of contamination.
 +
**External exposure to ionizing radiation
 +
***document location and position of patient relative to source of radiation at time of exposure, as well as time and duration of exposure (including dosimeter information if applicable)
 +
*CBC q6-8h x 2-3 days
 +
*Amylase; baseline and at 24h post exposure
  
*unlikely use by terrorists since needs high level of expertise- but low yield weapon can be made or higher yield weapon could be stolen and used
+
==Management==
*even if nuc weapon fizzled- will still be big blast
+
*Can be localized or whole body, internal or external deposition and contamination
*destruction due to airblast and thermal radiation
+
*Mostly not emergency, just treatment symptoms and supportive care
*1 psi increase breaks glass
+
*Consider contacting health physicist and/or radiation safety officer for help
*12 psi 50% mortality
 
*fire ball -&gt; flash/ flame burns, blindness
 
*inonizing radiation released in first minute as intense pulse- is initial radiation
 
*residual radiation, after first minute is fission and activation products
 
*ground burst causes radioactive soil into atmsphre and fallout of hundreds of miles- fallout can be lethal at greater ranges than at the blast or fireball
 
  
== Basic Principles ==
+
===Localized Exposure===
 +
* Treat wounds symptomatically
 +
**Close wounds within 35-48 hours
 +
*By direct handling. patient survives even though dose high since exposure drops rapidly with distance
 +
*Treat [[burns]] with [[analgesia|pain control]], prophylactic [[antibiotics]], vasodilator treatment, surgery, skin graft,
 +
**Extent of penetration important factor in outcome
  
=== Physical Properties ===
+
===Whole Body Exposure===
 +
*[[Acute Radiation Syndrome]]
 +
Those persons who receive a significant exposure from radiation may experience acute radiation syndrome (ARS),  a systemic illness caused by exposure to a level of ionizing radiation sufficient to cause damage to the hematopoietic, gastrointestinal, cardiovascular or central nervous system
 +
{| class="wikitable"
 +
|-
 +
! Dose !! SubSyndrome !! Potential Signs and Symptoms
 +
|-
 +
|  || N/A || Subclinical
 +
|-
 +
| 1 GY (100 rad) || Hematopoietic || Lymphocytopenia – 24-48 hours
 +
(worsens with increasing dose)
 +
[[Thrombocytopenia]], [[Anemia]] - weeks
  
*gamma and xrays- deep penetration
+
|-
*alpha- hazard only if ingested/ inoculated since penetration &lt;0.1mm
+
| 6 Gy (600 rad) || Gastrointestinal || [[Nausea/vomiting]], [[diarrhea]] with resulting [[hypovolemia]] and electrolyte shifts,
*beta/ electrons- penetrate a few centimeters
+
|-
*Rads- is dose absorbed by specific tissue. internation unit for absorbed dose is "gray" Gy. 1 gy = 100 rads
+
| 10 Gy (1000 rad)|| Neurovascular || Nausea, [[headache]], lethargy, [[ataxia]], [[confusion]], [[seizures]]
*different radioactive particles have diff effects at same absorbed dose- so use effective dose for comparison
+
|-
*effective dose is "REM". 100 rem = 1 sievert
+
|}
*one gray = one sievert when dealing with gamma and beta rays
+
**Within 12hr, [[nausea/vomiting]] for 48hr
*effect of radiation based on time of exp, distance and shielding
+
**Dose >30 gy: cardiovascular and CNS effects - [[hypotension]], cerebral edema, [[seizure]], [[nausea/vomiting]]/[[diarrhea]], [[ataxia]], [[cardiac arrest|death]]
*dose decreases rapidly with square of distance and decreases on 1/9th if triple distance
+
**Dose 10-30 gy: GI syndrome: [[nausea and vomiting]]/[[diarrhea]], then latent for 1 week, then recurrent nausea and vomiting/diarrhea this time with [[sepsis]] and death
*shield with lead or stay indoors
+
*Hematopoietic symptoms- dose 2gy or higher- [[leukopenia|lymphocyte reduction]] within 48 hrs is indicator for rad exposure. get leukopenia and [[thrombocytopenia]]- bleeding and infection- may enhance recovery by hematopoietic factors
*radiation decays with time
+
*Cutaneous symptoms- damaged skin may interact with other organ damage
*short lived- iodines
+
*Amifostine- prophylactic radiation drug- causes hypotension as side effect
*long- cesium, stontium, cobalt
+
*Androstenediol- boosts immune system
*rate of decay also effects dose of exposure and may effect management decisions
+
*Bone marrow transplant not helpful
 +
*Even if treatment and survive hematopoetic symptoms, still die from radiation pneumonitis, denuded GI tract, hepatic and renal dysfunction
  
=== Biological Principles ===
+
===Internal Contamination===
 +
*May enter thru burns, wounds, inhale, ingest
 +
*Need to know type of radionuclide and chemical form
 +
*Need to treatment quickly to be effective
 +
*Reduce absorption, dilute, blockage, displacement by nonradioactive materials, mobilization, chelation
 +
*Potassium iodine for nuc weapon detonation or reactor breach- prevents radioiodine from accumulating in thyroid. take shortly after exp to be effective- if give too much get iodism
 +
*Dose- 130mg adults, 65mg 3- 18ys, 32mg 1mo- 3yr, 16mg for age< 1mo
 +
*Chelators- calcium, zinc, only for plutonium or americium
  
*some cells may die but if cells role not critical for survival, may not see effect
+
===External Contamination===
*rapidly dividing cells- gi and bone marrow, most vulnerable
+
*Clothes and exp skin- just clean up and prevent spread
*dose &lt;1gy, cells survive but get CA later
+
*Clean with soap and water
*radiation induced CA dose related
+
*If extremis- stabilize first, then decontam
*leukemia within 2 yrs, solid tumors 5-10 or more yrs
+
*Do not abraid skin while cleaning
  
== Treatment ==
+
===Contaminated Burns and Wounds===
 +
#Irrigate
 +
#Excise only if long acting radionuclides
 +
#If whole body dose >1gy, close wound asap to prevent portal of infc
 +
#In burns, radioactivity comes off with eschar and exudate
  
*can be localized or whole body, internal or external deposition and contamination
+
==Disaster Management==
*mostly not emergency, just tx sxs and supportive care
+
*Preparation, crisis management, consequences  
 
 
=== Localized Exposure ===
 
 
 
*by direct handling. pt survives eventhough dose high since exposure drops rapidly with distance
 
*rad burn like thermal burn- but signs can occur after a few days, vasc insuff after several months and causing necrosis of previously healed skin
 
*tx c pain control, infc prophylaxsis, vasodilator tx, surg, skin graft,
 
*extent of penetration important factor in outcome
 
*beta rays from fallout only burn exposed skin
 
 
 
=== Whole Body Exposure ===
 
 
 
*Acute Radiation Syndrome
 
**Within 12hr, N/V for 48hr
 
**Dose &gt;30 gy: CV and CNS effects - hypotension, cerebral edema, sz, n/v/d, ataxia, death
 
**Dose 10-30 gy: GI syndrome: N/V/D, then latent for 1 wk, then recurrent n/v/d this time with sepsis and death
 
*hematopoetic syn- dose 2gy or higher- lymphocyte reduction within 48 hrs is indicator for rad exposure. get leukopenia and thrombocytopenia- bleeding and infc- may enhance recovery by hematopoetic factors
 
*cutaneous syn- damaged skin may interact with other organ damage
 
*amifostine- prophylactic radiation drug- causes hypotn as side effect unfortunately
 
*androstenediol- boosts immune system
 
*bone marrow xplant not helpful
 
*even if tx and survive hematopoetic syn, still die from radiation pneumonitis, denuded gi tract, hepatic and renal dysfunction
 
 
 
=== Internal Contamination ===
 
 
 
*may enter thru burns, wounds, inhale, ingest
 
*need to know type of radionuclide and chemical form
 
*need to tx quickly to be effective
 
*reduce absorption, dilute, blockage, displacement by non radioactive materials, mobilization, chelation
 
*potassium iodine for nuc weapon detonation or reactor breach- prevents radioiodine from accumulating in thyroid. take shortly after exp to be effective- if give too much get iodism
 
*dose- 130 mg adults, 65 mg 3- 18ys, 32 mg 1mo- 3yr, 16 mg for age&lt; 1mo
 
*chelators- calcium, zinc, only for plutonium or americium
 
 
 
=== External Contamination ===
 
 
 
*clothes and exp skin- just clean up and prevent spread
 
*clean with soap and water
 
*if extremis- stabilize first, then decontam
 
*do not abraid skin while cleaning
 
 
 
=== Contaminated Burns and Wounds ===
 
 
 
#irrigate
 
#excise only if long acting radionuclides
 
#if whole body dose &gt;1gy, close wound asap to prevent portal of infc
 
#in burns, radioactivity comes off with eschar and exudate
 
 
 
== Disaster Management ==
 
 
 
*preparation, crisis management, consequences  
 
 
*FBI is lead agency in terrorist incident  
 
*FBI is lead agency in terrorist incident  
*during consequence management, FEMA fed emerg management agency takes over  
+
*During consequence management, FEMA fed emerg management agency takes over  
*intervention- action to reduce exp and dose of radtn
+
*Intervention- action to reduce exposure and dose of radiation
*if dose 1 rem- stay in doors up to 2 days- evacuate for 1 wk if dose of 5 rem or more  
+
*If dose 1 rem- stay in doors up to 2 days- evacuate for 1 wk if dose of 5 rem or more  
*temp relocation if dose 3 rem in first month or 1 rem in subsequent month  
+
*Temperature relocation if dose 3 rem in first month or 1 rem in subsequent month  
*permanent resettlement if lifetime dose 100 rem  
+
*Permanent resettlement if lifetime dose 100 rem  
*pot iodine only if thyroid dose 100 mgy or more  
+
*Potassium iodine only if thyroid dose 100mgy or more  
*EMS occupational dose of 5 rem per yr dose not apply- allowable dose goes up for life saving event  
+
*EMS occupational dose of 5 rem per yr dose not apply- allowable dose goes up for lifesaving event  
*at dose of 0.1 gy/hr- ems may go in for short time but dose maybe life threatening
+
*At dose of 0.1 gy/hr- ems may go in for short time but dose may be life threatening
  
=== Early Management ===
+
==See Also==
 +
*[[Dirty bomb]]
 +
*[[Disaster medicine]]
 +
*[[Radiation exposure (clinical)]]
 +
*[[Acute Radiation Syndrome]]
  
*evacuate upwind if possible
+
==References==
 +
<References/>
  
[[Category:Rads]] [[Category:Tox]] [[Category:EMS]]
+
[[Category:Radiology]]  
 +
[[Category:Toxicology]]  
 +
[[Category:EMS]]
 +
[[Category:Military]]

Latest revision as of 15:18, 14 October 2019

Background

  • “Ionizing” radiation is electromagnetic or particulate which can create charged particles or ions
  • "Non-ionizing radiation" ( e.g., light, microwaves, and radiowaves) does not have sufficient energy to eject an electron from another atom
  • Ionization of biologically important molecules, e.g., DNA, can cause cellular death
  • Ionizing radiation at higher doses can cause damage to actively dividing and undifferentiated cell types, e.g., stem and progenitor cells in the bone marrow, gastrointestinal system, and skin

Radiological and Nuclear Scenarios of Concerns

  • Radiological exposure devices
  • Radiological dispersal devices
  • Nuclear power plant incidents/accidents
  • Improvised nuclear devices

Radiological Exposure Devices (RED)

  • A RED is a device that can cause exposure to ionizing radiation without the knowledge of the person being exposed
  • Surreptitious placement of a RED could delay discovery and notification of the healthcare community
  • Injury is based on the radiation dose received, whether accidental or intentional in nature
  • A concealed RED scenario could result in serious injuries

Radiological Dispersal Devices (RDD)

  • Any device used to spread radioactive material; more commonly thought of as an explosive device or “dirty bomb"
  • Do not necessarily need to explode in order to spread radiological material into the environment
    • Non-explosive RDD could cause environmental contamination that could lead to human contamination (e.g. use in facility ventilation systems, fumigation systems, etc.)
  • Explosion of an improvised explosive devices (IED) with radioactive material could cause additional injury, internal contamination, and panic
  • Persons near the epicenter of an explosion of a dirty bomb will sustain physical trauma, thermal burns, and embedded foreign bodies including radioactive shrapnel.
  • Amount of physical damage from RDD would depend on amount and type of explosives used; additional radiological consequences would depend on source and physical properties as well as explosive device
  • Removal of foreign bodies would require healthcare providers wear PPE and have access to radiation monitoring equiment (e.g. ring dosimeters)
  • Management of internal contamination via inhalation or wounds might be required for some patients

Nuclear Power Plant (NPP) Incident/Accident

  • The Fukushima Japan nuclear power plant disaster in March of 2011 was highly unusual and the first time that such a serious situation at a nuclear power plant resulted from an environmental disaster.
  • Nuclear power plants use the energy created by the fissioning of atomic nuclei ("splitting" of the atom) to generate electricity. *Heat generated during fission process converts water to steam, which then is used to drive electricity-generating turbines
  • Loss of power to coolant pumps can allow reactor core to overheat, which can then cause the radioactive core to "melt-down".

Nuclear Device Detonation

  • 3 forms of energy released by nuclear detonation[1]
    • Heat (35% of total)
    • Shock or bomb blast (50%)
    • Radiation (15%)
  • The detonation of any kind or size of nuclear weapon would be expected to cause massive physical damage to a community and untold psychological devastation to its population. In 2009, the National Security Staff released the first edition of Planning Guidance for the Response to a Nuclear Detonation10 In this document, planners categorized the devastation, types of physical damage, and types of human injuries based upon distance from the detonation epicenter in zones. The second edition of this document, released in June 2010, updated recommendations and guidance based on intensive modeling efforts to try to further quantify the effects of a nuclear detonation in an urban American city. Part of the updates to the guidance includes further refinement of the proposed damage zones. The document’s authors called the area closest to the epicenter the Severe Damage (SD) zone; the adjacent area the Moderate Damage (MD) zone; and the affected area furthest away from the epicenter, the Light Damage (LD) zone. In addition, a dangerous fallout (DF) radiation zone, which is determined by the scattering of radiological material, is also defined3. The presumed “safe” and “dangerous” distances away from the epicenter vary from scenario to scenario in modeling efforts and would be made after-the-fact by the incident commander based upon types of damage found on the ground. Zone determinations would depend upon:
  • The yield of the weapon
  • Whether the detonation was at a height or at ground level, and
  • The topographical features of the terrain and its structures.

Basic Principles

Physical Properties

  • Radiation Types
    • Gamma and xrays - deep penetration
    • Alpha - hazard only if ingested/ inoculated since penetration only ~0.1mm
    • Beta/electrons - penetrate only a few centimeters
  • Dose
    • Rads - dose absorbed by specific tissue.
    • Gray (Gy) - international unit for absorbed dose. (1 Gy = 100 rads)
    • REM - "Effective Dose" (100 rem = 1 sievert = 1 Gy)
  • Principles of exposure
    • Different radioactive particles have diff effects at same absorbed dose- so use effective dose for comparison
    • Effect of radiation based on time of exp, distance and shielding
    • Dose decreases rapidly with square of distance and decreases on 1/9th if triple distance
    • Lead is an effective shield
  • Radiation decays with time
    • Iodine isotopes are short lived
    • Cesium, stontium, cobalt are longer-lived
    • Rate of decay also effects dose of exposure and may effect management decisions

Biological Principles

  • Some cells may die but if cells role not critical for survival, may not see effect
  • Rapidly dividing cells (e.g. GI and bone marrow) are most vulnerable
  • Dose ~1Gy, cells survive but get cancer later
  • Radiation-induced cancer dose related
  • Leukemia within 2 yrs, solid tumors 5-10 or more yrs
  • Beta rays from fallout only burn exposed skin

Clinical Features

  • Presentation dependant on nature of exposure
  • Radiation burn like thermal burn but signs can occur after a few days, vascular insufficiency after several months and causing necrosis of previously healed skin

Differential Diagnosis

Mass casualty incident

Evaluation

  • Evaluate and stabilize any life threatening physical injuries (ABC's)
  • Decontaminate after stabilized
    • Check for external contamination
      • document location, dose rate and/or count measurements initial and after decontamination, and description of decontamination methods/agents used
    • Check for internal contamination
      • swab both nostrils
      • 24-hour stool and 24-hour urine samples
      • Identify radionuclide (chemical form), solubility and particle character
      • Document suspected route of contamination.
    • External exposure to ionizing radiation
      • document location and position of patient relative to source of radiation at time of exposure, as well as time and duration of exposure (including dosimeter information if applicable)
  • CBC q6-8h x 2-3 days
  • Amylase; baseline and at 24h post exposure

Management

  • Can be localized or whole body, internal or external deposition and contamination
  • Mostly not emergency, just treatment symptoms and supportive care
  • Consider contacting health physicist and/or radiation safety officer for help

Localized Exposure

  • Treat wounds symptomatically
    • Close wounds within 35-48 hours
  • By direct handling. patient survives even though dose high since exposure drops rapidly with distance
  • Treat burns with pain control, prophylactic antibiotics, vasodilator treatment, surgery, skin graft,
    • Extent of penetration important factor in outcome

Whole Body Exposure

Those persons who receive a significant exposure from radiation may experience acute radiation syndrome (ARS), a systemic illness caused by exposure to a level of ionizing radiation sufficient to cause damage to the hematopoietic, gastrointestinal, cardiovascular or central nervous system

Dose SubSyndrome Potential Signs and Symptoms
N/A Subclinical
1 GY (100 rad) Hematopoietic Lymphocytopenia – 24-48 hours

(worsens with increasing dose) Thrombocytopenia, Anemia - weeks

6 Gy (600 rad) Gastrointestinal Nausea/vomiting, diarrhea with resulting hypovolemia and electrolyte shifts,
10 Gy (1000 rad) Neurovascular Nausea, headache, lethargy, ataxia, confusion, seizures
  • Hematopoietic symptoms- dose 2gy or higher- lymphocyte reduction within 48 hrs is indicator for rad exposure. get leukopenia and thrombocytopenia- bleeding and infection- may enhance recovery by hematopoietic factors
  • Cutaneous symptoms- damaged skin may interact with other organ damage
  • Amifostine- prophylactic radiation drug- causes hypotension as side effect
  • Androstenediol- boosts immune system
  • Bone marrow transplant not helpful
  • Even if treatment and survive hematopoetic symptoms, still die from radiation pneumonitis, denuded GI tract, hepatic and renal dysfunction

Internal Contamination

  • May enter thru burns, wounds, inhale, ingest
  • Need to know type of radionuclide and chemical form
  • Need to treatment quickly to be effective
  • Reduce absorption, dilute, blockage, displacement by nonradioactive materials, mobilization, chelation
  • Potassium iodine for nuc weapon detonation or reactor breach- prevents radioiodine from accumulating in thyroid. take shortly after exp to be effective- if give too much get iodism
  • Dose- 130mg adults, 65mg 3- 18ys, 32mg 1mo- 3yr, 16mg for age< 1mo
  • Chelators- calcium, zinc, only for plutonium or americium

External Contamination

  • Clothes and exp skin- just clean up and prevent spread
  • Clean with soap and water
  • If extremis- stabilize first, then decontam
  • Do not abraid skin while cleaning

Contaminated Burns and Wounds

  1. Irrigate
  2. Excise only if long acting radionuclides
  3. If whole body dose >1gy, close wound asap to prevent portal of infc
  4. In burns, radioactivity comes off with eschar and exudate

Disaster Management

  • Preparation, crisis management, consequences
  • FBI is lead agency in terrorist incident
  • During consequence management, FEMA fed emerg management agency takes over
  • Intervention- action to reduce exposure and dose of radiation
  • If dose 1 rem- stay in doors up to 2 days- evacuate for 1 wk if dose of 5 rem or more
  • Temperature relocation if dose 3 rem in first month or 1 rem in subsequent month
  • Permanent resettlement if lifetime dose 100 rem
  • Potassium iodine only if thyroid dose 100mgy or more
  • EMS occupational dose of 5 rem per yr dose not apply- allowable dose goes up for lifesaving event
  • At dose of 0.1 gy/hr- ems may go in for short time but dose may be life threatening

See Also

References

  1. Waselenko JK, MacVittie TJ, Blakely WF, et al. Medical management of the acute radiation syndrome: recommendations of the Strategic National Stockpile Radiation Working Group. Ann Intern Med. 2004 Jun 15;140(12):1037-51.