Acute Radiation Syndrome
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Acute Radiation Syndrome

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Acute Aadiation Syndrome

Acute Aadiation Syndrome
http://decode-medicine.blogspot.com/2011/03/acute-radiation-syndrome.html

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    Acute Radiation Syndrome Acute Radiation Syndrome Presentation Transcript

    • Acute Radiation Syndrome
    • Pathophysiology
      Strips electrons from atomic nuclei, damaging cellular DNA; rapidly dividing tissues (GI, hematopoietic, epidermal) are most susceptible to ionizing radiation.
    • Cytogenetic abnormalities noted after irradiation in peripheral blood lymphocytes of a patient exposed to high-dose radiation.
      Dicentric chromosomes and ring abnormalities are relatively radiationspecific
      and are characteristic of changes observed.
      dicentric
      chromosome
      ring
      aberration
      fragments
      normal
      chromosome
    • Units of Radiation
      Exposure
      Units of activity describe the amount of radioactivity present
      Conventional unit: Roentgen
      Absorbed dose
      Units of exposure measure the amount of X-ray or gamma radiation that produces a given number of ionizations in air
      Conventional unit: rad
      International system of unit: Gray
      1 Gy = 100 rad
      Dose equivalent
      Units of absorbed dose can be applied to any type of radiation and reflect the energy imparted to matter
      Conventional unit: Roentgen equivalents man (rem)
      International system of unit: Sievert
      1 Sv = 100 rem
    • *1 rem (dose equivalent) = 1 rad (absorbed dose or exposure)
    • Acute Radiation Syndrome
    • Phases of Radiation Injury
      Ann Intern Med. 2004;140:1037–1051.
    • Acute Radiation Syndrome
      Stage I: Prodromal stage
      (chieflygastrointestinal)
      Onset: minutes to hours
      ARS is fatal if GI symptoms
      develop within 2-4 hrs
      Duration: 48-72 hrs
      Presentation: nausea, vomiting;
      also diarrhea, cramps
    • Acute Radiation Syndrome
      Stage II: Latent stage
      (chieflyhematopoietic)
      Onset: hours to days
      Duration: 1.5-2 wks
      Presentation: asymptomatic
       bone marrow supression
    • Acute Radiation Syndrome
      Stage III: Manifest stage
      (multisystem involvement)
      Onset: 3-5 wks
      Duration: variable
      Presentation:
      CNS/CVS (>15 Sv)
      Cardiorespiratory/GI system (>5 Sv)
      Reticuloendothelial system (>1 Sv)
    • Acute Radiation Syndrome
      Stage IV: Recovery or Death
      Onset: weeks
      Duration: weeks to months
      Presentation: leading cause of death
      before recovery is sepsis
    • Typical hematologic course and clinical stages after sublethal (~3 Gy) exposure to total-body irradiation
    • Prognosis According to the Lymphocyte Count within the First 48 Hours after Acute Exposure to Penetrating Whole-Body Radiation
      Ann Emerg Med. 2005;45:643-652.
    • Commonly Treated Forms of Internal Contamination
    • Top 10 Key Points For Medical Management of Radiation Casualties
      Medical Treatment of Radiological Casualties: Current Concepts
      Ann Emerg Med. 2005;45:643-652
    • All patients should be medically stabilized from their traumatic injuries, without delay, before radiation injuries are considered.
      Patients are then evaluated for either external radiation exposure or radioactive contamination.
    • An external radiation source with enough intensity and energy can cause tissue damage (eg, skin burns or marrow depression).
      This exposure from a source outside the person does not make the person radioactive. Even such lethally exposed patients are no hazard to medical staff.
    • Nausea, vomiting, diarrhea, and skin erythema within 4 hours may indicate very high (but treatable) external radiation exposures. Such patients will show obvious lymphopenia in 8 to 24 hours. Evaluate with serial CBCs.
      Primary systems involved will be skin, intestinal tract, and bone marrow. Treatment may involve fluids, antimicrobial agents, transfusions, and marrow-stimulating factors.
      In cases involving explosions, during the ED phase of treatment, early hypotension and CNS changes from radiation effects may be indistinguishable from trauma-related causes. If there are early CNS findings or unexplained hypotension, survival is unlikely.
    • Radioactive material may have been deposited on or in the person (contamination).
      More than 90% of surface radioactive contamination may be removed by removal of the clothing. Most remaining contamination on exposed skin is effectively removed with soap, warm water, and a washcloth.
      Do not damage skin by overvigorous scrubbing.
    • Protect yourself from radioactive contamination by observing standard precautions, including protective clothing, gloves, and a mask.
    • Radioactive contamination in wound or burns should be handled as if it were simple dirt.
      If an unknown metallic object is encountered, it should be handled only with instruments such as forceps and saved in a protected or shielded area for forensic analysis.
    • In a terrorist incident, there may be continuing exposure of the public that is essential to evaluate. Initially suggest sheltering and a change of clothing or showering. Evacuation may be necessary.
      Administration of potassium iodide is indicated only when there has been a confirmed release of radioiodine.
    • When there is any type of radiation incident, many persons will want to know whether they have been exposed or are contaminated.
      Provision needs to be made to potentially screen thousands of such persons.
    • Clinically significant acute radiation syndrome seldom if ever occurs in people receiving less than 1 Gyof whole-body radiation. The risk of developing cancer after exposure to radiation is a function of the dose received and begins to accrue even with very low doses (ie, there is no minimum threshold dose).
      For contaminated patients, the amount of radioactivity present is measured in bequerels (Bq) (1 disintegration per second). Sometimes, it may be also expressed in counts per minute.
      Decontamination is usually stopped if the item is reduced to 2 or 3 times the background count rate or if repeated decontamination efforts are ineffective at further reducing the count rate.
    • The principles of time/distance/shielding are key. Even in the treatment of Chernobyl workers, doses to the medical staff were only about 10 mGy or 10 mSv. Doses to first responders at the scene, however, can be much higher, and appropriate dose-rate meters must be available for evaluation.
      Radiation dose is diminished by reducing time spent in the radiation area (moderately effective), increasing distance from a radiation source (very effective), or using metal or concrete shielding (less practical).
    • Reference
      Radiation Injuries. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 2011, pp 56-61
      Disaster Management and Emergency Preparedness. Advanced Trauma Life Support, 2008, pp 333-334
      Medical Treatment of Radiological Casualties: Current Concepts. Ann Emerg Med. 2005;45:643-652