Exposure: Diagnose/Manage Acute Radiation Syndrome
(Text Version)

Management Modifiers Burns Trauma Mass casualty Timing of surgery Blood products use At-risk/special needs populations

1. Evaluate for Acute Radiation Syndrome (ARS) (What Is ARS?)
2. Look for Signs of ARS
   • Perform targeted physical examination
3. Estimate Dose from Exposure
   • Use any clinical data available (Interactive Tools)
     • Lymphocyte depletion kinetics
     • Time to onset of vomiting
     • Prodromal symptoms
     • Chromosome analysis (dicentrics)
   • Dose reconstruction by patient location
     • Match patient location to exposure map
4. Begin Assessment & Management
   • Assess/manage 4 sub-syndromes of ARS:
     hematopoietic, gastrointestinal, cutaneous, neurovascular
   • Does patient need outpatient or inpatient management? (Response category tool)
   • Plan for evolution of ARS over time
   • Expect heterogeneity of signs/symptoms
   • Consider using template for hospital orders
5. Special Issues
   • Manage ARS with scarce resources (e.g., after nuclear detonation)
   • Consider white cell cytokines to mitigate neutropenia if dose > 2 gray
   • Consider multi-organ dysfunction and multi-organ failure syndromes of ARS
   • Consider hematopoietic stem cell transplant for severe ARS
6. For Deceased
   • Decedents with exposure only and no contamination require no special radiation precautions
   • Register decedent in incident database
7. For Survivors
   • Discharge with appropriate follow-up instructions
   • Register patient in incident database
   • Radiation follow-up considerations
     • Whole-body dose
     • Immune status
     • Risk of cancer
     • Risk of specific organ dysfunction