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viernes, 31 de marzo de 2017

Ionizing Radiation Injuries and Illnesses

emDocs - March 30, 2017 - Authors: Simon E and Sessions D - Edited by: Koyfman A
"Key Pearls
  • Get help – the radiation safety officer/organizational protocols, and toxicologist should be able to provide information regarding instrumentation, resources for containment, and treatment.
  • Protect yourself – always ensure appropriate PPE.
  • Address the patient:
    • Decontamination – remove clothing, irrigate all open wounds with saline, gently wash skin with mild soap.
    • Trauma patient – surgery within the first 36 hours optimum.
    • Stable patient with symptoms of ARS – treat nausea/emesis (ondansetron, granisetron), give sucralfate (stress ulcers), give CSF (≥ 2 Gy with mechanical trauma, children < 12 years of age, and the elderly), start neutropenia prophylaxis.
      • Symptom onset within 2 hours of exposure => ASSUME LETHAL DOSE.
    • Send labs:
      • CBC, chromosome studies; start urine and feces collection if internal contamination.
        • ALC: clinical marker of severity
    • Transfusion Required:
      • Irradiated, leukoreduced blood products
          • Maintain platelets > 20,000 (>75,000 if surgery required).
        • Iodine, cesium, thallium, plutonium, americium, or curium exposure: talk to the toxicologist for recommendations regarding therapy."