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."