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Acute radiation cns syndrome & neurological damage caused by chemical agents

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Acute radiation cns syndrome & neurological damage caused by chemical agents

  1. 1. ACUTE RADIATION CNS SYNDROME & NEUROLOGICAL DAMAGE CAUSED BY CHEMICAL AGENTS Deepak Agrawal Assistant Professor, Neurosurgery, JPNATC, AIIMS, N Delhi
  2. 2. ARS- Definition <ul><li>An acute illness caused by irradiation of the entire body (or most of the body) by a high dose of penetrating radiation in a very short period of time </li></ul>
  3. 3. PREREQUISITES <ul><li>The radiation dose must be large </li></ul><ul><li>The dose usually must be external </li></ul><ul><li>The radiation must be penetrating </li></ul><ul><li>The entire body </li></ul><ul><li>The dose must have been delivered in a short time </li></ul>
  4. 4. ARS Syndromes <ul><li>Central Nervous System (CNS) syndrome </li></ul><ul><li>Bone marrow syndrome </li></ul><ul><li>Gastrointestinal (GI) syndrome </li></ul>
  5. 5. Central Nervous System (CNS) syndrome <ul><li>dose greater than approximately 50 Gy (5000 rads) </li></ul><ul><li>Death occurs within 3 days. </li></ul>
  6. 6. Four stages of ARS <ul><li>Prodromal stage (N-V-D stage) </li></ul><ul><li>Latent stage </li></ul><ul><li>Manifest illness stage </li></ul><ul><li>Recovery or death </li></ul>
  7. 7. Patient Management <ul><li>Triage </li></ul><ul><li>Secure ABCs </li></ul><ul><li>Treat major trauma, burns and respiratory injury </li></ul><ul><li>Obtain blood samples for CBC (complete blood count), lymphocyte count, and HLA </li></ul><ul><li>Treat contamination </li></ul><ul><li>repeat CBC approximately every 2 to 3 hours </li></ul>
  8. 8. Management Andrews Lymphocyte Nomogram
  9. 9. Management <ul><li>Treat vomiting and repeat CBC analysis </li></ul><ul><li>Record all clinical symptoms </li></ul>
  10. 10. Management <ul><li>supportive care in a clean environment (prevention and treatment of infections) </li></ul><ul><li>stimulation of hematopoiesis by use of growth factors </li></ul><ul><li>stem cell transfusions or platelet transfusions (if platelet count is too low) </li></ul><ul><li>psychological support </li></ul>
  11. 11. Management <ul><li>careful observation for erythema (document locations), hair loss, skin injury, mucositis, parotitis, weight loss, or fever </li></ul><ul><li>confirmation of initial dose estimate using chromosome aberration cytogenetic bioassay when possible. </li></ul><ul><li>consultation with experts in radiation accident management </li></ul>
  12. 12. NEUROLOGICAL DAMAGE CAUSED BY CHEMICAL AGENTS
  13. 14. <ul><li>Organophosphate </li></ul><ul><li>colourless, odourless gas with a lethal dose of just 0.5mg for an adult human (or 0.01mg/kg of body weight). </li></ul><ul><li>Competitive inhibition of the enzyme acetyl cholinesterase </li></ul>SARIN
  14. 15. SARIN <ul><li>ROUTES OF EXPOSURE </li></ul><ul><li>Inhalation </li></ul><ul><li>skin contact </li></ul><ul><li>eye contact </li></ul><ul><li>Ingestion is an uncommon route of exposure. </li></ul>
  15. 16. SARIN <ul><li>SYMPTOMS </li></ul><ul><li>Diarrhea, diaphoresis </li></ul><ul><li>Urination </li></ul><ul><li>Miosis </li></ul><ul><li>Bradycardia, bronchospasm, </li></ul><ul><li>Vomiting </li></ul><ul><li>Lacrimation, salivation </li></ul><ul><li>Weakness, Paralysis </li></ul>
  16. 17. Sarin <ul><li>INDICATIVE LAB TESTS </li></ul><ul><li>Decreased cholinesterase </li></ul><ul><li>Increased anion gap </li></ul><ul><li>Metabolic acidosis </li></ul>
  17. 18. DECONTAMINATION <ul><li>The hydrolysis reaction is rapid and used for the decontamination of affected areas: </li></ul><ul><li>Solids, powders and solutions containing various types of bleach ( NaOCl- or Ca(OCl-)2 ) </li></ul>
  18. 19. DECONTAMINATION <ul><li>DS2 ( 2% NaOH, 70% diethylenetriamine, 28% ethylene glycol monomethyl ether ) </li></ul><ul><li>Towlettes moistened with NaOH dissolved in water, phenol, ethanol and ammonia </li></ul>
  19. 20. TREATMENT <ul><li>Triage </li></ul><ul><li>Secure ABCs </li></ul><ul><li>Antidote </li></ul><ul><li>Diazepam (5 to 10 mg in adults and 0.2 to 0.5 mg/kg in children) may be used to control convulsions. </li></ul>
  20. 21. ANTIDOTE <ul><li>Atropine and pralidoxime chloride (2-PAM Cl) are antidotes for nerve agent toxicity </li></ul><ul><li>2-PAM Cl (25mg/Kg i/m) must be administered within minutes to a few hours (depending on the agent) following exposure to be effective. </li></ul><ul><li>Atropine (2-4mg i/m) should be administered every 5 to 10 minutes until secretions begin to dry up. </li></ul>
  21. 22. SARIN <ul><li>DELAYED EFFECTS OF EXPOSURE : Patients/victims who have severe exposure should be evaluated for persistent central nervous system (CNS) effects. </li></ul><ul><li>EFFECTS OF CHRONIC OR REPEATED EXPOSURE </li></ul>
  22. 23. THANK YOU

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