Acute Radiation Syndrome (ARS)

• What is ARS?
• What is exposure?
• What are the time phases of classical ARS?
• Estimate dose from exposure
• Perform targeted physical exam
• Consider these tools for clinical diagnosis and treatment
• Special clinical issues
• Multimedia resources
• References

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What is ARS?

• Dictionary definition including 4 subsyndromes: hematologic, gastrointestinal, cutaneous, neurovascular
  • More on Hematopoietic subsyndrome
  • More on Cutaneous radiation subsyndrome
• Managing Subsyndromes of ARS: hematologic, gastrointestinal, cutaneous, neurovascular
  • Interactive tool to help manage ARS
  • Video explaining how to use the tool

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What is exposure?

• Animated illustrations

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What are the time phases of classical ARS?

• Phases
  • Prodromal
  • Latent
  • Manifest Illness (Critical Phase)
  • Recovery or Death
• The higher the dose, the faster the time of onset, the shorter the time between phases, the more severe the illness
• Interactive illustrations of phases and time dose effects
  • Time Phases of the Acute Radiation Syndrome
  • Time Dose Effects in ARS

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Estimate dose from exposure

• Dose Estimator (Biodosimetry Tools)
  • Tools for estimating dose
  • Video explaining how to use the tool
• Explaining Biodosimetry - Frequently asked questions
• Dose Reconstruction - Location, duration, shielding (geographic dosimetry)

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Perform targeted physical exam

• Targeted physical exam

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Consider these tools for clinical diagnosis and treatment

• REMM clinical algorithm for exposure
  • Exposure algorithm
  • Video explaining the tool
• Template for adult/pediatric orders after a radiation incident
• Other radiation injury management algorithms
• Tool for managing ARS
  • Interactive tool to help manage ARS
  • Video explaining how to use the tool
• The hematopoietic subsyndrome of ARS
• The cutaneous subsyndrome of ARS
• Expert consultation from the Radiation Injury Treatment Network (RITN)
• Dose magnitude estimation information to help inform medical management of radiation incidents (ORAU)
• Manage ARS with scarce resources after an IND detonation
  • Interactive tool
  • Video explaining how to use the tool
• Multi-organ dysfunction syndrome: a new hypothesis about radiation injury

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Special clinical issues

• Use of Blood Products - guidelines and warnings
• Burns and radiation exposure: combined injury
• Trauma and radiation exposure: combined injury
• Timing of surgery
• Caution about prescribing aspirin and NSAIDs in irradiated patients
• Multi-organ dysfunction syndrome
• Clinical course after high dose whole body radiation
• Management of febrile neutropenia
• Myeloid cytokines
• Hematopoietic stem cell transplant
• Antiemetics

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Multimedia resources

• Time/dose effects in ARS
  • Interactive tool
  • Video explaining this tool
• Time phases of ARS
  • Interactive tool
  • Video explaining this tool
• Radiation effects on blood counts
  • Lymphocyte depletion kinetics graph (Andrews)
  • Radiation effects on blood counts (Verobiev)
  • Radiation effects on blood counts (Fliedner)
  • Radiation effects on blood counts (TMT Handbook)
• Radiation Injury Treatment Network (RITN) Videos
  • Just in time Training Module: ARS Primer for Healthcare Providers (YouTube - 16:10 min)
  • What you Need to Know about What is RITN and How it Works? (YouTube - 4:17 min)
• Lethality as a Function of Dose and LD_50/60

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References

• Medical Management of Radiation Injury - REMM Bibliography
• Hematopoietic Subsyndrome
• Cutaneous Radiation Subsyndrome
• Myeloid Cytokines
• Radiation Injury Treatment Network (See Reference Materials on tab at top.)

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