Nuclear Emergency Medicine

Steven Podnos MD

Intial Steps

• Ensure Medical Stability (ACLS,ATLS)• Decontamination• Admit for Severe exposure, otherwise

outpatient management

Radiation is the transfer of energy through space

• Ionizing particles: • Beta Particles, low energy , few cm

penetration, short lived• Alpha particles-stop at skin, only a problem if

internalized• Gamma and Xrays are high energy, pass

through tissue, need lead to stop• Neutron, (and Gamma) highly penetrating

Two types of clinical effects

• Stochastic: increased risk of cancer and genetic mutations Not necessarily dose related in terms of severity, but is related in terms of likelihood of occurence

• Deterministic-dose related clinical effects-hematologic suppression, cataracts, tissue fibrosis, decreased fertility

Measuring Exposure

• One Rad=• Rem=effect of absorbing one Rad

(approximate)• Gy=100 Rads• Sv

Types of Exposure

• Radiation-no contamination implied• External Contamination• Internal Contamination

Irradiation

• Use lymphocyte counts in nomogram to calculate severity of exposure

• Lethal doses of radiation acutely are 2-400 rads (a head CT is one rad). Average annual radiation exposure is 600mREM

Acute Radiation Syndrome

• Prodrome-Nausea, Vomiting, Abd pain, fever• Latent-patient feels better, but not making

cells well• Manifest Phase-skin, blood vessels, GI

mucosa, Bone Marrow deficiencies, Fibrosis• Recovery or Death Phase-

Radiation from Nuclear Plant Accidents

• Ionizing Radiation-Immediate and Residual• Immediate Gamma Ray irradiation• Residual induced radioactivity of soil, etc • Fallout-immediate and delayed

Triage

• Onset of vomiting prodrome within 3 hours suggests serious if not fatal dose. However, must be differentiated from psychogenic causes, so use lymphocyte depletion nomogram