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Radiation Pocket Guide
Diagnosis: Be alert to the following:
Acute radiation syndrome follows a predictable pattern after substantial exposure or catastrophic event. Victims may also present individually, over a longer period of time after exposure to contaminated sources hidden in the community. Specific syndromes of concern, especially with a 2 to 3 week prior history of nausea and vomiting are:
Thermal burn-like skin lesions without documented heat exposure
Immunological dysfunction with secondary infections
A tendency to bleed (epistaxis, gingival bleeding, petechiae)
Marrow suppression (neutropenia, lymphonenia, and thrombocytopenia)
Epilation (hair loss)
Simultaneous disease outbreaks in human and animal or bird populations.
Unusual temporal or geographic clustering of illness (for example, patients who attended the same public event, live in the same part of town, etc.)
Understanding Exposure. Exposure may be known and recognized or clandestine through:
large radiation exposures, such as a nuclear bomb or catastrophic damage to a nuclear power station small radiation source emitting continuous gamma radiation producing chronic intermittent exposures (such as radiological sources from medical treatment or industrial devices)
Exposure to radiation may result from any one or combination of the following:
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external sources (such as radiation from an uncontrolled nuclear reaction or radioisotope outside the body)
skin contamination with radioactive material internal radiation from absorbed, inhaled, or ingested radioactive material
Decontamination Considerations.
Externally irradiated patients are not contaminated. Treating contaminated patients before decontamination may contaminate the facility. Plan for decontamination before arrival. Exposure without contamination requires universal precautions, removal of patient clothing, and decontamination with soap and water. For internal contamination, contact the RSO and/or Nuclear Medicine Physician. Patient with life-threatening condition: treat, then decontaminate Patient with non-life-threatening condition: decontaminate, then treat.
Treatment Consideration
If life-threatening conditions are present, treat them first. If external radioactive contaminants are present, decontaminate. -
If radioiodine (reactor accident) is present, consider protecting the thyroid gland with prophylactic potassium iodide if within first few hours only (ineffective later)
Acute Radiation Syndromes
Prodromal Phase
Feature: Nausea, vomiting
Time of Onset
Subclinical range: 100 to 200 rad - 3 to 6 hours Sublethal range:200 to 600 rad - 2 to 4 hours, 600 to 800 rad - 1 to 2 hours
Lethal range: 800 to 3000 rad - <1 hours, 3000 rad to >30 Gy - minutes
Latent Phase(subclinical)
Feature: Absence of symptoms
Time of Onset
Subclinical range: 0 to 100 rad - > 2 weeks, 100 to 200 rad -7 to 15 days
Sublethal range: 200 to 600 rad - 0 to 7 days, 600 to 800 rad - 0 to 2 days
Acute Radiation Illness Manifest (illness phase)
Subclinical range: 0 to 100 rad - none, 100 to 200 rad - moderate leukopenia Sublethal range: 200 to 600 rad - severe leukopenia, purpura, hemorrhage, pneumonia, hair loss after 300 rad, 600 to 800 rad - same as above Lethal range: 800 to 3000 rad - diarrhea, fever, electrolyte disturbance, >3000 rad > 30 Gy - convulsions, ataxia, tremor, lethargy
Time of Onset
Subclinical range0 to 100 rad -100 to 200 rad - > 2 weeks Sublethal range - 2 days to 2 weeks Lethal range - 1 to 3 days
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