D A baseline serum amylase level should be obtained to evaluate for parotitis; repeat in 24 hours. Exposures above 0. Electrolyte levels should be obtained when necessary.
E Obtain blood and tissue typing, if the examination suggests a high-dose exposure. These patients may need bone marrow, umbilical cord blood, or peripheral stem cells due to pancytopenia. F If the history indicated possible inhalation or ingestion of radioactive materials, a hour urine collection should be obtained for analysis, using any properly labeled sealed container.
In addition, if inhalation may have occurred, nasal swabs should be obtained from each nostril, the amount of radiation in each should be measured with a handheld counter, and the 2 counts should be added. This amount divided by 0. G Cytogenetic dosimetry, the gold standard method of measurement, should be ordered and obtained after 24 hours to determine the actual dose absorbed by the patient.
However, there are only 2 laboratories in the United States that perform cytogenetic dosimetry and results are not available for a few days. Although high intensity external radiation can cause tissue damage eg, skin burns or marrow depression , it does not make the patient radioactive.
However, all staff should be in scrubs covered with a water resistant gown or a Tyvek R suit. A cap, mask, and shoe covers should be worn, and 2 pairs of plastic gloves worn with the first pair taped to the gown or suit. Dosimeters should be worn at the collar but under the protective clothing. The history obtained at the scene is of great importance. The exact type of exposure ie, internal versus external and partial versus whole body exposure should be obtained.
The main goals of therapy for acute radiation syndrome are prevention of neutropenia and sepsis. Examine the patient and repeat at 6 hours and 12 hours. Monitor vital signs, including temperature; the sooner the temperature rises, the greater the dose received. Trauma or other urgent medical or surgical situations should be managed prior to treatment for radiation exposure. Treat patients with persistent nausea and vomiting with granisetron or ondansetron.
Delayed neutrons are emitted by excited nuclei formed in beta decay of fission products called delayed neutron precursors. About 1% of the. Delayed neutrons are emitted by excited nuclei formed in beta decay of fission products called delayed neutron precursors. About 1% of the total neutrons.
Early oral feedings are recommended to maintain gut function. All emesis should be collected for the first few days, saving for later analysis. Antidiarrheals may be used to control diarrhea. Internal contamination may require treatment with radiation countermeasure agents such as potassium iodide radioactive iodine exposure , prussian blue cesium and thallium exposure , or chelating agents plutonium, americium, curium exposure.
However, these agents do not protect against external radiation absorption and acute radiation syndrome. Patients who develop infection without neutropenia should have antibiotic therapy directed towards the source of infection and the most likely pathogen. Treatment includes pain management, infection prevention, and vasodilators. Palliative care should be started immediately, with initial treatment in the ICU if resources allow. A radiation detector passed over the body held at a consistent distance from the body can detect residual contamination. Further decontamination is accomplished by washing with warm soap and water, with gentle brushing while covering open wounds.
Reduction of radiation to less than 2 times the background level is the goal of decontamination. Contaminated wounds require further effort. Abrasions are decontaminated with warm water and soap. Lacerations may require excision of contaminated tissue. Punctate lesions may be successfully cleaned using a water pick or oral irrigator. Shrapnel should be removed with forceps. Gastric lavage may be used if ingestion occurred within 1 to 2 hours, and large ingestions may benefit from cathartics and enemas.
If corneal contamination is present and globe is intact, carefully irrigate eyes with copious amounts of saline or water. Never irrigate a ruptured globe. To avoid contamination of nasolacrimal duct, direct irrigation stream away from inner canthus and toward outer canthus. Monitor the eyes for conjunctivitis after decontamination.
The irrigation fluid should be tested frequently for residual radioactivity. Collect, store, and label irrigation fluid properly for forensic evaluation and proper disposal. It should be documented whether any decontamination has occurred, and if any loss of consciousness was experienced.
If trauma occurred, the mechanism of injury should be determined, and any medication use and allergy history recorded. Ingested radioactivity can be measured from collected urine. If inhalation may have occurred, nasal swabs should be taken as soon as possible in order to determine the approximate radiation exposure; combine the 2 measurements and divide by 0. Similar measurements may be taken from contaminated wounds.
In all cases, the measurements can be converted into a measure of activity and compared with charts of known annual limits of intake to determine if the amount of radiation internally present is hazardous and requires treatment. Specific medical countermeasures may be employed to treat internal contamination, some of which depend on the specific radionuclide that has been ingested or inhaled. Endotracheal intubation and mechanical ventilation may rarely be required. Nebulized inhalation: 1 g in dilution with water or NS. If febrile neutropenia develops, consultation with infectious disease and hematology specialists should be obtained, and guidelines on febrile neutropenia from the Infectious Disease Society of America should be followed for appropriate antibiotic therapy.
Patients who received doses of 7 to 10 Gy to rads should be considered for bone marrow stem cell transplants. If transfusion of blood products is required, all products should leukoreduced and irradiated to 25 Gy in order to avoid a transfusion-related graft-vs-host reaction. Follow-up instructions should include a repeat CBC in 48 hours and reevaluation following the onset of any gastrointestinal symptoms eg, nausea, vomiting, and diarrhea.
Hospital admission is also necessary for standard indications for multiple trauma or burns associated with radiation exposure. Other conditions eg, multiple trauma may necessitate transporting patients to a trauma center. After stabilization, decontamination, and initial evaluation, patients with the hematopoietic syndrome should be transferred to a facility with expertise in the treatment of pancytopenia.
If transfer is indicated, it should be undertaken on the first day or as soon as possible. Appropriate therapy may be delayed due to failure to contact a radiation specialist. Beware of secondary exposures that may come from rescuers who were also exposed. History of radiation exposure may be difficult to obtain in some settings. Following absorption, a radionuclide crosses capillary membranes through passive and active diffusion mechanisms and then is distributed throughout the body.
Rate of distribution to each organ is dependent on organ metabolism, ease of chemical transport, and the affinity of the radionuclide for chemicals within the organ. The organs with the highest capacities for binding radionuclides are the liver, kidney, adipose tissue, and bone due to their high protein and lipid makeup.
Each radionuclide has a unique half-life, with half-lives ranging from extremely short fraction of a second to millions of years. Samples of some radionuclides and their half-lives are: Tcm: 6 hours; I 8. Nasal swabs should be taken as soon as possible in order to determine the approximate radiation exposure; combine the 2 measurements and divide by 0. Specific medical countermeasures may be employed to treat internal contamination, some of which depend on the specific radionuclide that has been inhaled. One rad equals 0. One Gy equals rads or 1 joule per kilogram. One sievert Sv is equivalent to rems, where 1 rem is 1 Gy multiplied by a factor that depends on the type of radiation received.