Nuclear emergency medicine
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Nuclear emergency medicine

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Nuclear emergency medicine Nuclear emergency medicine Presentation Transcript

  • Nuclear Emergency Medicine Steven Podnos MD
  • Intial Steps• Ensure Medical Stability (ACLS,ATLS)• Decontamination• Admit for Severe exposure, otherwise outpatient management
  • Radiation is the transfer of energy through space• Ionizing particles:• Beta Particles, low energy , few cm penetration, short lived• Alpha particles-stop at skin, only a problem if internalized• Gamma and Xrays are high energy, pass through tissue, need lead to stop• Neutron, (and Gamma) highly penetrating
  • Two types of clinical effects• Stochastic: increased risk of cancer and genetic mutations Not necessarily dose related in terms of severity, but is related in terms of likelihood of occurence• Deterministic-dose related clinical effects- hematologic suppression, cataracts, tissue fibrosis, decreased fertility
  • Measuring Exposure• One Rad=• Rem=effect of absorbing one Rad (approximate)• Gy=100 Rads• Sv
  • Types of Exposure• Radiation-no contamination implied• External Contamination• Internal Contamination
  • Irradiation• Use lymphocyte counts in nomogram to calculate severity of exposure• Lethal doses of radiation acutely are 2-400 rads (a head CT is one rad). Average annual radiation exposure is 600mREM
  • Acute Radiation Syndrome• Prodrome-Nausea, Vomiting, Abd pain, fever• Latent-patient feels better, but not making cells well• Manifest Phase-skin, blood vessels, GI mucosa, Bone Marrow deficiencies, Fibrosis• Recovery or Death Phase-
  • Radiation from Nuclear Plant Accidents• Ionizing Radiation-Immediate and Residual• Immediate Gamma Ray irradiation• Residual induced radioactivity of soil, etc• Fallout-immediate and delayed
  • Triage• Onset of vomiting prodrome within 3 hours suggests serious if not fatal dose. However, must be differentiated from psychogenic causes, so use lymphocyte depletion nomogram