1. The document outlines planning considerations and medical management strategies for major radiological emergencies involving radiation exposure devices, nuclear weapons detonation, nuclear reactor meltdowns, or dirty bombs.
2. It describes the health effects of radiation exposure which depend on dose, part of body exposed, rate and type of radiation. Acute effects include radiation sickness while long term risks include cancer induction.
3. The document provides guidance on assessing and treating external contamination, internal contamination, and radiation injury. Key principles include decontamination and urgent stabilization of life-threatening trauma while closely monitoring for delayed radiation effects.
Acute Radiation Disease or Acute Radiation Syndromes.Dmitri Popov
An Acute Radiation Disease is a particular abnormal condition, a disorder of a structures or functions, or functions, that affects part or all of an irradiated organism. The causal study of disease is called pathology. Acute Radiation Disease is a medical condition associated with specific symptoms and signs.
Corna virus detail And corona virus in pakistanEmaan Uppal
The 2019–20 coronavirus pandemic is a pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was first identified in Wuhan, Hubei, China in December 2019Avoiding close contact with sick individuals; frequently washing hands with soap and water; not touching the eyes, nose, or mouth with unwashed hands; and practicing good respiratory hygiene.
Hospital Aquired Infections with special consideration to surgical site infections...also case presentation in the begining followed by literature review
The purpose of radiation protection is to provide an appropriate level of protection for humans without unduly limiting the beneficial actions giving rise to radiation exposure. Radiation protection is to prevent the occurrence of harmful deterministic effects and to reduce the probability of occurrence of stochastic effects (e.g. cancer and hereditary effects).The ICRP recommends, develops and maintains the International System of Radiological Protection, based on evaluation of the large body of scientific studies available to equate risk to received dose levels. The system's health objectives are "to manage and control exposures to ionising radiation so that deterministic effects are prevented, and the risks of stochastic effects are reduced to the extent reasonably achievable The ICRP's recommendations flow down to national and regional regulators, which have the opportunity to incorporate them into their own law; this process is shown in the accompanying block diagram. In most countries a national regulatory authority works towards ensuring a secure radiation environment in society by setting dose limitation requirements that are generally based on the recommendations of the ICRP.There are three basic principles of radiation protection: justification, optimization, and dose limitation. Justification involves an appreciation for the benefits and risks of using radiation for procedures or treatments. Physicians, surgeons, and radiologic personnel all play a key role in educating patients on the potential adverse effects of radiation exposure. The benefits of exposure should be well known and accepted by the medical community. Often, procedures that expose patients to relatively higher doses of radiation—for example, interventional vascular procedures—are medically necessary, and thus the benefits outweigh the risks. The As Low as Reasonably Achievable (ALARA) principle, defined by the code of federal regulations, was created to ensure that all measures to reduce radiation exposure have been taken while acknowledging that radiation is an integral part of diagnosing and treating patients. Any amount of radiation exposure will increase the risk of stochastic effects, namely the chances of developing malignancy following radiation exposure. These effects are thought to occur as a linear model in which there is no specific threshold to predict whether or not malignancy will develop reliably. For these reasons, the radiologic community teaches protection practices under the ALARA principle.The duration of radiation exposure, distance from the radiation source, and physical shielding are the key facets in reducing exposure. The exposure duration can be minimized in several ways. When exposing a patient to radiation, the technician or physician should preplan the required images to avoid unnecessary and redundant exposure. Magnification significantly increases the exposure to the patient; therefore, magnification should be used judiciously and gently.
Acute Radiation Disease or Acute Radiation Syndromes.Dmitri Popov
An Acute Radiation Disease is a particular abnormal condition, a disorder of a structures or functions, or functions, that affects part or all of an irradiated organism. The causal study of disease is called pathology. Acute Radiation Disease is a medical condition associated with specific symptoms and signs.
Corna virus detail And corona virus in pakistanEmaan Uppal
The 2019–20 coronavirus pandemic is a pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was first identified in Wuhan, Hubei, China in December 2019Avoiding close contact with sick individuals; frequently washing hands with soap and water; not touching the eyes, nose, or mouth with unwashed hands; and practicing good respiratory hygiene.
Hospital Aquired Infections with special consideration to surgical site infections...also case presentation in the begining followed by literature review
The purpose of radiation protection is to provide an appropriate level of protection for humans without unduly limiting the beneficial actions giving rise to radiation exposure. Radiation protection is to prevent the occurrence of harmful deterministic effects and to reduce the probability of occurrence of stochastic effects (e.g. cancer and hereditary effects).The ICRP recommends, develops and maintains the International System of Radiological Protection, based on evaluation of the large body of scientific studies available to equate risk to received dose levels. The system's health objectives are "to manage and control exposures to ionising radiation so that deterministic effects are prevented, and the risks of stochastic effects are reduced to the extent reasonably achievable The ICRP's recommendations flow down to national and regional regulators, which have the opportunity to incorporate them into their own law; this process is shown in the accompanying block diagram. In most countries a national regulatory authority works towards ensuring a secure radiation environment in society by setting dose limitation requirements that are generally based on the recommendations of the ICRP.There are three basic principles of radiation protection: justification, optimization, and dose limitation. Justification involves an appreciation for the benefits and risks of using radiation for procedures or treatments. Physicians, surgeons, and radiologic personnel all play a key role in educating patients on the potential adverse effects of radiation exposure. The benefits of exposure should be well known and accepted by the medical community. Often, procedures that expose patients to relatively higher doses of radiation—for example, interventional vascular procedures—are medically necessary, and thus the benefits outweigh the risks. The As Low as Reasonably Achievable (ALARA) principle, defined by the code of federal regulations, was created to ensure that all measures to reduce radiation exposure have been taken while acknowledging that radiation is an integral part of diagnosing and treating patients. Any amount of radiation exposure will increase the risk of stochastic effects, namely the chances of developing malignancy following radiation exposure. These effects are thought to occur as a linear model in which there is no specific threshold to predict whether or not malignancy will develop reliably. For these reasons, the radiologic community teaches protection practices under the ALARA principle.The duration of radiation exposure, distance from the radiation source, and physical shielding are the key facets in reducing exposure. The exposure duration can be minimized in several ways. When exposing a patient to radiation, the technician or physician should preplan the required images to avoid unnecessary and redundant exposure. Magnification significantly increases the exposure to the patient; therefore, magnification should be used judiciously and gently.
Journal Club - Mortality after Fluid Bolus in African Children with Severe In...Farooq Khan
Critical Appraisal of:
Maitland K, Kiguli S, Opoka RO, et al. Mortality after fluid bolus in African children with severe infection. N Engl J Med 2011;364:2483-95
Research in International Emergency Medicine: Scope, Impact and Challenges
EBM Topic: Subgroup Analysis
Journal Club - Utility of Absolute and Relative Changes in Cardiac Troponin C...Farooq Khan
Critical Appraisal of:
Reichlin et al. Utility of Absolute and Relative Changes in Cardiac Troponin Concentrations in the Early Diagnosis of Acute Myocardial Infarction.Circulation. 2011;124:136-145
Novel High-sensitivity Troponin Assays
EBM topic: ROC curves
Journal club - Disease progression in hemodynamically stable patients present...Farooq Khan
Critical appraisal of:
Glickman SW et al. Disease Progression in Hemodynamically Stable Patients Presenting to the Emergency Department With Sepsis. Acad Emerg Med. 2010 17:383-90
Interactive quiz on early goal-directed therapy, surviving sepsis guidelines and EBM topic of prognosis studies.
Journal Club - EMS - "Effect of adrenaline on survival in out-of-hospital car...Farooq Khan
Summary and Critical Appraisal of:
Jacobs et al,"Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial" Resuscitation 82 (2011) 1138– 1143
Introduction to Injury Prevention - An interactive discussion for senior and ...Farooq Khan
Introducing concepts of Injury Prevention to mid-level Emergency Care Providers in the District Hospital setting in rural Sub-Saharan Africa.
An interactive lecture made for the Global Emergency Care Collaborative.
Emerging and Re-emerging Infectious DiseasesFarooq Khan
Overview of literature around the following emerging and re-emerging infectious diseases relevant to Canadian Emergency Physicians in terms of their epidemiology, recognition, and treatment:
- Community-acquired MRSA
- Non-vaccine serotype Pneumococcus
- Fusobacterium Necrophorum
Approach to evaluating patients' fitness to drive during an ED encounter.
Review of health advocacy and legal obligations from a Quebec standpoint
Audience: Medical students and residents in a small group environment
Approach to Fever in the Returning TravelerFarooq Khan
Quick diagnostic approach to return travelers presenting to the ED with fever.
Audience: Medical Students and Junior Residents in a small group environment
Approach to fever in the transplant patientFarooq Khan
Quick Approach to solid organ transplant patients presenting to the ED with fever to guide initial work-up and managment.
Audience: Medical students and junior residents in a small group environment
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Thyroid Gland- Gross Anatomy by Dr. Rabia Inam Gandapore.pptx
Medical response to a major radiologic emergency - handout
1. Adapted from Wolbarst et al, Medical Response to a Major Radiologic Emergency: A Primer for Medical and Public Health Practitioners. Radiology:
Volume 254: Number 3—March 2010
Medical Response to a Major Radiologic Emergency
Planning in radio-nuclear (R/N) events revolves around 4 basic scenarios
Detonation of a nuclear weapon
Meltdown of a nuclear reactor,
Explosion of a large radiologic dispersal device (“dirty bomb”)
Surreptitious placement of a radiation exposure device in a public area of high population density
Basic concepts in Radiological exposures
Units (traditional vs SI) are in almost all emergency situations numerically equivalent
Absorbed dose is a measure of the actual energy deposited in an irradiated mass
Equivalent dose adds a measure of biological impact of the radiation type
Effective dose is an aggregation of per tissue/organ estimates of the Equivalent dose weighted for the sensitivity
of the organs involved, giving an estimate of the impact of absorbed dose on an organism
Health effects of radiation
Depend on:
Dose absorbed
Part of the body exposed
Rate
Route
Type (ɑ, β, γ, x rays or neutrons)
Stochastic effects
o Random effects of transformation of genetic material within 1 or more cells, with increasing probability of
occurrence with dose, but may occur even at low dose. E.g. carcinogenesis
Farooq Khan MDCM
PGY3 FRCP-EM
McGill University
November 14
th
2011
2. Adapted from Wolbarst et al, Medical Response to a Major Radiologic Emergency: A Primer for Medical and Public Health Practitioners. Radiology:
Volume 254: Number 3—March 2010
Deterministic effects
o Predictable dose-dependent effect of radiation-induced acceleration of cellular processes, damage or apoptosis
leading to organ dysfunction. Can be acute or late in onset.
General Principles of Radiation Safety
Direct exposure to ionizing radiation
o Patients nearby during or after a R/N event, irradiated but not rendered radioactive or contaminated
themselves.
Contamination with radioactive materials
o Patients around contaminated objects, environments or people having now contaminated themselves through
various routes. HCPs should wear PPE and keep exposure as low as reasonable achieved (ALARA).
ALARA principles
Minimize time
Maximize distance
Use shielding when appropriate,
Ensure prompt removal or containment of contamination
Type of radiological contamination
ɑ-particles: large, slow moving, deposit energy locally, cannot traverse epidermis. Internal hazards
β- particles: can penetrate several cm into skin. Internal and external hazard
γ and x-rays: non-particulate, high energy radiation capable of penetrating the whole body and require
lead or concrete shielding. Internal and external hazards
External contamination
Clothing should be removed and placed in identified radio-hazard bags
Surveys with sealed radiation detection equipment should start with open wounds, then facial orifices followed
by skin
Nasal and buccal swabs should be taken for analysis
Gentle irrigation of wounds followed by usual scrubbing of skin is appropriate, use waterproof paper for run-off
into plastic garbage containers or bags that can be disposed of separately. Dab away excess fluid 1 gauze at a
time. Perform another detection survey after irrigation before proceeding with surgical closure; small amounts
of contamination is acceptable before closure.
Repeat survey-wash-rinse sequence until readings drop to 2-3× background levels.
Whole body shower is rarely needed.
Internal contamination
Via inhalation, ingestion, percutaneous transdermal, or open wounds/abrasions.
Little can or needs to be done acutely
Specialized equipment and expertise is required to assess for and prevent organ uptake (e.g. iodine in the
thyroid, or radium, americium or plutonium in the bone)
3. Adapted from Wolbarst et al, Medical Response to a Major Radiologic Emergency: A Primer for Medical and Public Health Practitioners. Radiology:
Volume 254: Number 3—March 2010
Protection of personnel
o Personnel in the proximity of or in contact with a few individuals who are lightly contaminated externally will be
exposed to ionizing radiation, although this generally (depending on the isotopes) involves very little risk.
o Personnel dealing with a multitude of more heavily contaminated patients, on the other hand, may accumulate
a substantial dose over time, unless they are careful and follow standard precautions against any hazardous
materials. Moreover, they can inadvertently transfer contamination to themselves and from there to others.
Planning and training
Protocol should be scalable, user-friendly, and directly outline each participant’s role.
Planning should be community-wide including:
Medical personnel, local public safety, public health, psychologic services, and emergency management officials,
together with first responders from fire departments, EMS, law enforcement, and other agencies.
At the ED level involve:
Radiation safety staff, the radiology and radiation oncology departments, security and communications, hospital
administration, clinical affairs, and public relations.
Components of plan include:
Personnel and resource management
Worker health and safety
o Establish common transport pathways, safe areas for family etc. In addition to PPE
Communication
o Establish and routinely test redundant systems, have back-ups for systems that could be incapacitated
by a nuclear blast.
4. Adapted from Wolbarst et al, Medical Response to a Major Radiologic Emergency: A Primer for Medical and Public Health Practitioners. Radiology:
Volume 254: Number 3—March 2010
ARS
See separate ARS handout for further details.
5. Adapted from Wolbarst et al, Medical Response to a Major Radiologic Emergency: A Primer for Medical and Public Health Practitioners. Radiology:
Volume 254: Number 3—March 2010
General Management Principles:
Dose estimated by
time to onset vomiting,
lymphocyte depletion rates,
distance from radioactive source
o Confirmed by dicentric chromosome analysis of swabs/tissues etc
Triage patients to
o Mild exposure
Many individuals who arrive at the ED will be physically intact but emotionally traumatized
o Severe potentially life threatening exposure
With excellent supportive care, victims may recover following acute whole-body exposures of 5–6 Sv
o Highly likely to be fatal exposure
Patients rarely survive >10 Sv
Combined injury leads to more effects at low doses
in chaotic situation track the contamination status, diagnosis, and treatment of patients by attach a hard copy of the
medical record package, or at least a brief note, either to clothing or to a cord hung around the neck
heavy internal contamination is suspected, significant intervention may be required early on to prevent
incorporation of radionuclides into critical organs
6. Adapted from Wolbarst et al, Medical Response to a Major Radiologic Emergency: A Primer for Medical and Public Health Practitioners. Radiology:
Volume 254: Number 3—March 2010
Use diagnostic risk assessment and management algorithm below as a guide, tailored to specific situation
7. Adapted from Wolbarst et al, Medical Response to a Major Radiologic Emergency: A Primer for Medical and Public Health Practitioners. Radiology:
Volume 254: Number 3—March 2010
Immediate General Medical Care and Monitoring of the Heavily Exposed but
Potentially Salvageable Patient
First priority:
Acutely life- and limb-threatening medical and surgical conditions
Concurrent collection of medical history and the history of the event
Once the patient is stabilized:
Management of direct exposure and of external and internal contamination,
Signs and symptoms of radiation injury and/or illness might not appear for hours to days and sometimes weeks.
Loss of fluids and electrolytes:
particularly problematic in infants, children, and the elderly
Medication
Antiemetics
o Phenothiazines, like prochlorperazine or chlorpromazine not very effective
o 5-HT 3 receptor inhibitors like ondansetron (Zofran) may be required for radiation-induced vomiting
Pain control
Antimicrobials
o not needed immediately (infections do not appear for days)
o prophylaxis if doses high enough to cause ARS
o infection-directed antibiotics, antivirals, antifungals and antihelminthic agents
G-CSF and GM-CSF
Surgical Intervention
Try to do surgeries within 24-36h of exposure while patients are:
o not immunocompromised,
o have better wound healing
o no bleeding diathesis
Bone marrow stem cell transplant
For exposures of 6-10 Sv without comorbid conditions
Internal contamination
GM counters screen for γ and β (which is also detected by scintillators) ɑ and neutron difficult to detect
Once in the body, nearly all radioisotopes behave chemically exactly like stable isotopes of the same element
Thus management similar to treatment of poisoning, best carried out by EM physicians and medical toxicologists
Reduce uptake and/or enhance clearance with standard decon and detox techniques i.e. antacids or a cathartic
e.g. castor oil or Mg sulphate
Specific countermeasures for significant contamination by identified radionuclides, e.g. KI for radioiodines,
Zn/CA-DTPA for plutonium/americium, Prussian Blue for Cesium and Thallium, HCO3
-
for uranium renal toxicity
Children
Higher risk of pulmonary contamination (hyperventilate)
Tissues more sensitive to carcinogens
Psychologically less resilient