Radiation injury: Difference between revisions

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'''For patient information click [[Radiation injury (patient information)|here]]'''
'''For patient information click [[Radiation injury (patient information)|here]]'''
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{{Radiation injury}}
{{Radiation injury}}
{{CMG}}; {{AE}} {{CZ}}
{{CMG}}; {{AE}} {{CZ}}; {{Ochuko}}


==[[Radiation injury overview|Overview]]==


Patient Management
==[[Radiation injury classification|Classification]]==


Triage: If radiation exposure is suspected:
==[[Radiation injury pathophysiology|Pathophysiology]]==


* Secure ABCs (airway, breathing, circulation) and physiologic monitoring (blood pressure, blood gases, electrolyte and urine output) as appropriate.
==[[Radiation injury causes|Causes]]==
* Treat major trauma, burns and respiratory injury if evident.
* In addition to the blood samples required to address the trauma, obtain blood samples for CBC (complete blood count), with attention to lymphocyte count, and HLA (human leukocyte antigen) typing prior to any initial transfusion and at periodic intervals following transfusion.
* Treat contamination as needed.
* If exposure occurred within 8 to 12 hours, repeat CBC, with attention to lymphocyte count, 2 or 3 more times (approximately every 2 to 3 hours) to assess lymphocyte depletion.


===Initial Treatment and Diagnostic Evaluation===
==[[Radiation injury differential diagnosis|Differentiating Radiation Injury from other Diseases]]==


Treat vomiting, and repeat CBC analysis, with special attention to the lymphocyte count, every 2 to 3 hours for the first 8 to 12 hours following exposure (and every 4 to 6 hours for the following 2 or 3 days). Sequential changes in absolute lymphocyte counts over time are demonstrated below in the Andrews Lymphocyte Nomogram (see Figure 1). Precisely record all clinical symptoms, particularly nausea, vomiting, diarrhea, and itching, reddening or blistering of the skin. Be sure to include time of onset.
==[[Radiation injury risk factors|Risk Factors]]==


[[Image:radiation_graph.gif|left|thumb|300px|Figure 1. Andrews Lymphocyte Nomogram (From Andrews GA, Auxier JA, Lushbaugh CC. The Importance of Dosimetry to the Medical Management of Persons Exposed to High Levels of Radiation. In Personal Dosimetry for Radiation Accidents. Vienna : International Atomic Energy Agency; 1965)]]
==[[Radiation injury screening|Screening]]==
<br clear="left"/>
Note and record areas of erythema. If possible, take color photographs of suspected radiation skin damage. Consider tissue, blood typing, and initiating viral prophylaxis. Promptly consult with radiation, hematology, and radiotherapy experts about dosimetry, prognosis, and treatment options. Call the Radiation Emergency Assistance Center/Training Site (REAC/TS) at (865) 576-3131 (M-F, 8 am to 4:30 am EST) or (865) 576-1005 (after hours) to record the incident in the Radiation Accident Registry System.


===After consultation, begin the following (as indicated):===
==[[Radiation injury natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


* supportive care in a clean environment (if available, the use of a burn unit may be quite effective)
==[[Radiation injury diagnosis|Diagnosis]]==
* prevention and treatment of infections
[[Radiation injury history and symptoms|History and Symptoms]] | [[Radiation injury physical examination|Physical Examination]] | [[Radiation injury laboratory findings|Laboratory Findings]] | [[Radiation injury MRI|MRI]] | [[Radiation injury other imaging findings|Other Imaging Findings]] | [[Radiation injury other diagnostic studies|Other Diagnostic Studies]]
* stimulation of hematopoiesis by use of growth factors
* stem cell transfusions or platelet transfusions (if platelet count is too low)
* psychological support
* careful observation for erythema (document locations), hair loss, skin injury, mucositis, parotitis, weight loss, or fever
* confirmation of initial dose estimate using chromosome aberration cytogenetic bioassay when possible. Although resource intensive, this is the best method of dose assessment following acute exposures.
* consultation with experts in radiation accident management.


==Source==
==Treatment==
[[Radiation injury medical therapy|Medical Therapy]] | [[Radiation injury surgery|Surgery]] | [[Radiation injury primary prevention|Primary Prevention]]  | [[Radiation injury cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Radiation injury future or investigational therapies|Future or Investigational Therapies]]


==Case Studies==
[[Radiation injury case study one|Case #1]]
==External Links==
*[http://www.bt.cdc.gov/radiation/arsphysicianfactsheet.asp#table1 Centers for Disease Control and Prevention]
*[http://www.bt.cdc.gov/radiation/arsphysicianfactsheet.asp#table1 Centers for Disease Control and Prevention]
==References==
* Berger ME, O’Hare FM Jr, Ricks RC, editors. The Medical Basis for Radiation Accident Preparedness: The Clinical Care of Victims. REAC/TS Conference on the Medical Basis for Radiation Accident Preparedness. New York : Parthenon Publishing; 2002.
* Gusev IA , Guskova AK , Mettler FA Jr, editors. Medical Management of Radiation Accidents, 2 nd ed., New York : CRC Press, Inc.; 2001.
* Jarrett DG. Medical Management of Radiological Casualties Handbook, 1 st ed. Bethesda , Maryland : Armed Forces Radiobiology Research Institute (AFRRI); 1999.
* LaTorre TE. Primer of Medical Radiobiology, 2 nd ed. Chicago : Year Book Medical Publishers, Inc.; 1989.
* National Council on Radiation Protection and Measurements (NCRP). Management of Terrorist Events Involving Radioactive Material, NCRP Report No. 138. Bethesda , Maryland : NCRP; 2001.
* Prasad KN. Handbook of Radiobiology, 2 nd ed. New York : CRC Press, Inc.; 1995.
==Additional Resources==
*Michihiko Hachiya, ''Hiroshima Diary'' (Chapel Hill: University of North Carolina, 1955), ISBN 0-8078-4547-7.
*John Hersey, ''Hiroshima'' (New York: Vintage, 1946, 1985 new chapter), ISBN 0-679-72103-7.
*Ibuse Masuji, ''Black Rain'' (1969) ISBN 0-87011-364-X
*Ernest J. Sternglass, ''Secret Fallout: low-level radiation from Hiroshima to Three-Mile Island'' (1981) ISBN 0-07-061242-0 ([http://www.ratical.org/radiation/SecretFallout/ online])
*Norman Solomon, Harvey Wasserman ''Killing Our Own: The Disaster of America's Experience with Atomic Radiation, 1945-1982'', New York: Dell, 1982. ISBN 0-385-28537-X, ISBN 0-385-28536-1, ISBN 0-440-04567-3 ([http://www.ratical.org/radiation/KillingOurOwn/ online])
*George N. Hamawy, ''A Brief Introduction to Radiation Safety'' (Tucson, Arizona: Wheatmark, 2007), [http://amzn.to/ftiS7P ISBN 1587368935]
==External links==
* [http://bjr.birjournals.org/cgi/reprint/Supplement_27/1/41.pdf Radiation accidents with multi-organ failure in the United States]
* [http://bjr.birjournals.org/cgi/reprint/Supplement_27/1/41.pdf Radiation accidents with multi-organ failure in the United States]
* [http://www.johnstonsarchive.net/nuclear/radevents/radaccidents.html List of radiation accidents and other events causing radiation casualties]
* [http://www.johnstonsarchive.net/nuclear/radevents/radaccidents.html List of radiation accidents and other events causing radiation casualties]
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* [http://www.bt.cdc.gov/radiation/arsphysicianfactsheet.asp The Center for Disease Control's fact sheet on Acute Radiation Syndrome]
* [http://www.bt.cdc.gov/radiation/arsphysicianfactsheet.asp The Center for Disease Control's fact sheet on Acute Radiation Syndrome]
* [http://courses.cs.vt.edu/~cs3604/lib/Therac_25/Therac_1.html Therac-25 computerized radiation therapy machine accidents]
* [http://courses.cs.vt.edu/~cs3604/lib/Therac_25/Therac_1.html Therac-25 computerized radiation therapy machine accidents]


{{Consequences of external causes}}
{{Consequences of external causes}}


[[Category:Emergency medicine]]
[[Category:Emergency medicine]]

Latest revision as of 17:39, 22 April 2013

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Ogheneochuko Ajari, MB.BS, MS [3]

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