Radiation Pocket Guide
Diagnosis:
Be alert to the following
1.
Acute radiation syndrome follows a predictable pattern after substantial
exposure or catastrophic event..
2. Victims may also present individually, over a longer period of time
after exposure to contaminated sources hidden in the community.
3. Specific syndromes of concern, especially with a 2 to 3 week prior
history of nausea and vomiting are:
- Thermal burn-like skin lesions without documented heat exposure
- Immunological dysfunction with secondary infections
- A tendency to bleed (epistaxis, gingival bleeding, petechiae)
- Marrow suppression (neutropenia, lymphonenia, and thrombocytopenia)
- Epilation (hair loss)
4. Simultaneous disease outbreaks in human and animal or bird populations.
5. Unusual temporal or geographic clustering of illness (for example,
patients who attended the same public event, live in the same part of
town, etc.)
Understanding
Exposure
1.
Exposure may be known and recognized or clandestine through:
- large radiation exposures, such as a nuclear bomb or catastrophic
damage to a nuclear power station
- small radiation source emitting continuous gamma radiation producing
chronic intermittent exposures (such as radiological sources from medical
treatment or industrial devices)
2. Exposure to RADIATION may result from any one or combination of the
following:
- external sources (such as radiation from an uncontrolled nuclear reaction
or radiosisotope outside the body)
- skin contamination with radioactive material
-internal radiation from absorbed, inhaled, or ingested radioactive
material
Decontamination
Considerations
1.
Externally irradiated patients are not contaminated.
2. Treating contaminated patients before decontamination may contaminate
the facility. Plan for decontamination before arrival.
3. Exposure without contamination requires universal precautions, removal
of patient clothing, and decontamination with soap and water.
4. For internal contamination, contact the RSO and/or Nuclear Medicine
Physician.
5. Patient with life-threatening condition: treat, then decontaminate
6. Patient with non-life-threatening condition: decontaminate, then
treat.
Treatment
Consideration
1.
If life-threatening conditions are present, treat them first.
2. If external radioactive contaminants are present, decontaminate.
3. If radioiodine (reactor accident) is present, consider protecting the
thyroid gland with prophylatic potassium iodide if within first few hours
only (ineffective later)
Acute Radiation Syndromes
Prodromal
Phase
Feature - Nausea, vomiting
Time
of Onset
Subclinical range -
100 to 200 rad - 3 to 6 hours
Sublethal range -
200 to 600 rad - 2 to 4 hours
600 to 800 rad - 1 to 2 hours
Lethal range -
800 to 3000 rad - <1 hours
>3000 rad to >30 Gy - minutes
Latent
Phase
(subclinical)
Feature - Absence of symptoms
Time
of Onset
Subclinical range -
0 to 100 rad - > 2 weeks
100 to 200 rad -7 to 15 days
Sublethal range -
200 to 600 rad - 0 to 7 days
600 to 800 rad - 0 to 2 days
Lethal range - None
Acute
Radiation Illness
(Mainifest illness phase)
Signs
and symptoms -
Subclinical
range -
0 to 100 rad - none
100 to 200 rad - moderate leukopenia
Sublethal range -
200 to 600 rad - severe leukopenia, purpura, hemorrhage, pneumonia, hair
loss after 300 rad
600 to 800 rad - same as above
Lethal range -
800 to 3000 rad - diarrhea, fever, electrolyte disturbance
>3000 rad > 30 Gy - convulsions, ataxia, tremor, lethargy
Time
of Onset
Subclinical range -
0 to 100 rad -
100 to 200 rad - > 2 weeks
Sublethal range -
2 days to 2 weeks
Lethal range - 1 to 3 days