Radiation Exposure + Contamination:
Diagnose and Manage
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Assess external contamination
- Contact radiation safety officer
- Put on Personal Protective Equipment
- Assess contamination pattern with radiation survey meter
- Evaluate for radioactive shrapnel
- Document contamination pattern on a body diagram
- Swab each nostril separately to help estimate level of internal (lung) contamination
- Caution: Management Modifiers
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Assess external contamination
Decontaminate Whole Body
- Decontaminate either on-site or at other designated areas
- Follow decontamination procedures
- Re-scan patient with radiation survey meter
- Repeat decontamination until successful (Understand target levels for decon)
- Do not exceed 3 attempts (decon cycles)
- Special issues for infants and children
Evaluate if All Are True:
- Decontamination successful (Understand target levels for decon)
- Absent or minimal physical injury
- Whole/partial body dose from exposure likely to be < 2 Gy
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YES
- Send home with follow-up instructions
- Register in incident database
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NO
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Evaluate at medical facility
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Evaluate at medical facility
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- On-site / Prehospital
- Medical Facility / Hospital
Evaluate at Medical Facility
- Treat life- or limb-threatening injuries first
- Obtain serial CBCs with differential to evaluate possibility of exposure and ARS
- Remove any remaining radioactive shrapnel and shield it safely
- Surgical window of about 36-48 hours, depends on rate of dropping blood counts
- Treat non-life-threatening problems
Assess Internal Contamination
- Scan patient with radiation survey meter (caveat)
- Incident responders or radiation safety officer will identify the isotope(s)
- Swab each nostril separately to help estimate level of internal (lung) contamination
- Collect ≥70 mL spot urine sample for isotope measurement
- Consider total body radiation survey with modified hospital nuclear medicine equipment
Treat Internal Contamination of Specific Isotope
- Isotopes of Interest Table
- Countermeasures Table
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Decision to treat will depend on
- Level of internal contamination
- Risk/benefit (toxicity) profile of the countermeasure
- Size of radiation incident
- Availability of resources/personnel
- Likelihood that patient will survive
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Deceased
- Management of decedents with contamination
- Register decedent in incident database
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Survivors
- Discharge with appropriate follow-up instructions
- Register patient in incident database
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Radiation follow-up considerations
- Whole body dose
- Immune status
- Risk of cancer
- Risk of specific organ dysfunction