Cautionary Notes 2 for Exposure + Contamination Algorithm
- General Issues
- Some persons may be more exposed than contaminated; others more contaminated than exposed.
- The type of radiation event will determine the isotope(s) released and relative likelihood of exposure vs. contamination.
- Victims of RDD, nuclear explosion, nuclear reactor accident each have different exposure/contamination profiles.
- No single algorithm can be applied to every incident or every patient in an incident.
- Management Modifiers
- Clinical condition
- Stabilization of life- and limb-threatening injuries (e.g., major trauma) takes precedence over initial management of exposure or contamination.
- The percent body surface area and depth of burns as well as the extent of other injuries must be considered when prioritizing care for victims of high dose ionizing radiation exposure.
- Victims with burns to a significant percent of the body surface area PLUS high dose from exposure (i.e.,combined injury) will have a much poorer prognosis than those with radiation injury alone or burns alone. The same is true for radiation injury plus trauma (combined injury).
- Radioactive shrapnel can represent a more significant exposure risk to health care providers than "simple external contamination."
- Radioactive shrapnel and all instruments used to handle it should be properly shielded and sealed in a lead container and labeled by the Radiation Safety Officer for forensic evaluation and proper disposal.
- Additional factors that increase vulnerability to radiation effects
- Young or old age
- Chronic medical conditions, especially immunocompromise
- Pregnancy
- Resource availability
- Ability to diagnose and treat external/internal contamination and Acute Radiation Syndrome will be affected by available personnel, equipment, medical and pharmaceutical supplies.
- Typical Treatment Sequence
- Treat life- or limb-threatening injuries
- Necessary surgery should usually occur within 36-48 hours after high-dose radiation exposure, i.e., before white blood cell and platelet counts begin to decline significantly.
- With use of cytokines, expected kinetics of blood cell depletion may be altered and may extend the window for surgery (See Radiation Effects on Blood Counts).
- Perform external decontamination.
- Assess for internal contamination and determine need to treat with countermeasures.
- Observe for signs/symptoms of ARS.
- Consider early use of hematopoietic cytokines/growth factors when
- Environmental measurements or dose reconstruction in a geographical area suggest radiation doses to the population likely to cause ARS.
- Biodosimetry indicates exposure to high dose
- Logistical barriers to timely collection, labeling, and/or analysis of biological specimens may limit immediate utility of biodosimetry.
- Clinical assessment indicates high-dose exposure, even in absence of accurate biodosimetry information