Acute radiation syndrome - Revision history

Elcatracho: /* Management */

2021-02-01T19:45:37Z

Management

← Older revision		Revision as of 19:45, 1 February 2021
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	==Management==		==Management==
			*Typically risk of contamination to clinicians is minimal, therefore immediate treatment of life-threatening conditions takes precedence<ref>Hryhorczuk D, Theobald JL: Radiation injuries, in Walls RM, Hockberger RS, Gausche-Hill M, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 9. Philadelphia, Elsevier 2018, (Ch) 138:p 1805-1812</ref>
	*Aggressive supportive care is hallmark of ED management		*Aggressive supportive care is hallmark of ED management
	*[[Potassium iodide]] as thyroid protectant, at 130mg QD for adults, until radiation exposure ceases<ref>New York State Potassium Iodide (KI) and Radiation Emergencies: Fact Sheet. https://www.health.ny.gov/environmental/radiological/potassium_iodide/fact_sheet.htm.</ref>		*[[Potassium iodide]] as thyroid protectant, at 130mg QD for adults, until radiation exposure ceases<ref>New York State Potassium Iodide (KI) and Radiation Emergencies: Fact Sheet. https://www.health.ny.gov/environmental/radiological/potassium_iodide/fact_sheet.htm.</ref>

ClaireLewis at 20:10, 1 October 2019

2019-10-01T20:10:14Z

← Older revision		Revision as of 20:10, 1 October 2019
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	==Background==		==Background==
	*Also called radiation poisoning, radiation toxicity, or radiation sickness.		*Also called radiation poisoning, radiation toxicity, or radiation sickness.
	*Acute illness caused by exposure to high doses (at least 1 Gy)<ref name="SNSRWG">Waselenko JK, MacVittie TJ, Blakely WF, et al. Medical management of the acute radiation syndrome: recommendations of the Strategic National Stockpile Radiation Working Group. Ann Intern Med. 2004 Jun 15;140(12):1037-51.</ref> of ionizing radiation over a short period of time.		*Acute illness caused by [[radiation exposure (disaster)\|exposure]] to high doses (at least 1 Gy)<ref name="SNSRWG">Waselenko JK, MacVittie TJ, Blakely WF, et al. Medical management of the acute radiation syndrome: recommendations of the Strategic National Stockpile Radiation Working Group. Ann Intern Med. 2004 Jun 15;140(12):1037-51.</ref> of ionizing radiation over a short period of time.
	**1 Gray (Gy) = 100 rads		**1 Gray (Gy) = 100 rads
	*Generally requires exposure of whole body (or most of the body)		*Generally requires exposure of whole body (or most of the body)
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	====Bone Marrow Syndrome====		====Bone Marrow Syndrome====
	*Clinical syndrome seen at doses >100-200 rad (1-2 Gy)		*Clinical syndrome seen at doses >100-200 rad (1-2 Gy)
	**Smaller doses cause clinically insignificant pancytopenia)		**Smaller doses cause clinically insignificant [[pancytopenia]]
	*Lymphocytes depleted first, then granulocytes, platelets, and RBCs		*[[leukopenia\|Lymphocytes depleted]] first, then granulocytes, [[thrombocytopenia\|platelets]], and [[anemia\|RBCs]]
	**Lymphocyte depletion is predictable based on dose		**Lymphocyte depletion is predictable based on dose
	*Death usually secondary to infection or hemorrhage and poor healing		*Death usually secondary to [[infection]] or [[hemorrhage]] and poor healing
	**Doses >350 rad fatal within several months if untreated		**Doses >350 rad fatal within several months if untreated

	====Gastrointestinal (GI) Syndrome====		====Gastrointestinal (GI) Syndrome====
	*Syndrome occurs at 600-1000 rad (6-10 Gy)		*Syndrome occurs at 600-1000 rad (6-10 Gy)
	*~~Characterized by abdominal~~ pain, nausea, vomiting, diarrhea, ileus		*[[Abdominal pain]], [[nausea/vomiting]], [[diarrhea]], [[ileus]]
	*Death occurs within weeks secondary to multiorgan failure and sepsis if untreated		*Death occurs within weeks secondary to multiorgan failure and [[sepsis]] if untreated

	====Cardiovascular (CV)/Central Nervous System (CNS) Syndrome====		====Cardiovascular (CV)/Central Nervous System (CNS) Syndrome====
	*Syndrome occurs at >1000-2000 rad (10-20 Gy)		*Syndrome occurs at >1000-2000 rad (10-20 Gy)
	**At this dose, vomiting is suppressed		**At this dose, vomiting is suppressed
	**~~Characterized by ALOC~~, ~~dizziness~~, papilledema, ↓ DTRs, ataxia, coma		**[[Dizziness]], [[syncope\|LOC]], [[papilledema]], ↓ DTRs, [[ataxia]], [[coma]]
	*Doses >3500 rad (35 Gy) damage large blood vessels → cardiovascular failure, cerebral edema		*Doses >3500 rad (35 Gy) damage large blood vessels → [[sock\|cardiovascular failure]], [[elevated ICP\|cerebral edema]]
	*Doses >5000 rad (50 Gy) cause death within 48 hours		*Doses >5000 rad (50 Gy) cause death within 48 hours

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	====Prodromal Stage====		====Prodromal Stage====
	*Characterized by nausea and vomiting		*Characterized by [[nausea and vomiting]]
	**Other symptoms include: malaise, fever, conjunctivitis		**Other symptoms include: malaise, [[fever]], [[conjunctivitis]]
	**Doses over 1000 rad (10 Gy), vomiting is not seen in early symptoms		**Doses over 1000 rad (10 Gy), vomiting is not seen in early symptoms
	*Occurs within 48h-6d of exposure (at higher doses, can begin within minutes)		*Occurs within 48h-6d of exposure (at higher doses, can begin within minutes)

Rossdonaldson1: /* External Links */

2018-06-22T05:54:42Z

External Links

← Older revision		Revision as of 05:54, 22 June 2018
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	==External Links==		==External Links==
	*[https://emergency.cdc.gov/radiation/arsphysicianfactsheet.asp]		*https://emergency.cdc.gov/radiation/arsphysicianfactsheet.asp

	==References==		==References==

Rossdonaldson1: /* See Also */

2018-06-22T02:42:49Z

Mholtz: Text replacement - "qd" to "QD"

2017-07-07T12:19:09Z

Text replacement - "qd" to "QD"

← Older revision		Revision as of 12:19, 7 July 2017
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	==Management==		==Management==
	*Aggressive supportive care is hallmark of ED management		*Aggressive supportive care is hallmark of ED management
	*[[Potassium iodide]] as thyroid protectant, at 130mg qd for adults, until radiation exposure ceases<ref>New York State Potassium Iodide (KI) and Radiation Emergencies: Fact Sheet. https://www.health.ny.gov/environmental/radiological/potassium_iodide/fact_sheet.htm.</ref>		*[[Potassium iodide]] as thyroid protectant, at 130mg QD for adults, until radiation exposure ceases<ref>New York State Potassium Iodide (KI) and Radiation Emergencies: Fact Sheet. https://www.health.ny.gov/environmental/radiological/potassium_iodide/fact_sheet.htm.</ref>

	==Disposition==		==Disposition==

Mholtz at 05:58, 27 December 2016

2016-12-27T05:58:59Z

← Older revision		Revision as of 05:58, 27 December 2016
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	==Evaluation==		==Evaluation==
	*Clinical diagnosis, based on history and physical		*Clinical diagnosis, based on history and physical
	*Absolute lymphocyte count ~~(< 1500)~~ best prognosticator at 48hrs post-exposure<ref>Colwell CB: Radiation injuries, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 146: pp 1945-1951.</ref>		*Absolute lymphocyte count is the best prognosticator at 48hrs post-exposure<ref>Colwell CB: Radiation injuries, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 146: pp 1945-1951.</ref> (<1500 is abnormal and indicates a significant exposure)

	==Management==		==Management==

ClaireLewis: /* Management */

2016-11-14T01:25:13Z

Management

← Older revision		Revision as of 01:25, 14 November 2016
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	==Management==		==Management==
	*Aggressive supportive care is hallmark of ED management		*Aggressive supportive care is hallmark of ED management
	*Potassium iodide as thyroid protectant, at 130mg qd for adults, until radiation exposure ceases<ref>New York State Potassium Iodide (KI) and Radiation Emergencies: Fact Sheet. https://www.health.ny.gov/environmental/radiological/potassium_iodide/fact_sheet.htm.</ref>		*[[Potassium iodide]] as thyroid protectant, at 130mg qd for adults, until radiation exposure ceases<ref>New York State Potassium Iodide (KI) and Radiation Emergencies: Fact Sheet. https://www.health.ny.gov/environmental/radiological/potassium_iodide/fact_sheet.htm.</ref>

	==Disposition==		==Disposition==

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-23T13:57:51Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 13:57, 23 July 2016
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	{{Nausea and vomiting DDX}}		{{Nausea and vomiting DDX}}

	==~~Diagnosis~~==		==Evaluation==
	*Clinical diagnosis, based on history and physical		*Clinical diagnosis, based on history and physical
	*Absolute lymphocyte count (< 1500) best prognosticator at 48hrs post-exposure<ref>Colwell CB: Radiation injuries, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 146: pp 1945-1951.</ref>		*Absolute lymphocyte count (< 1500) best prognosticator at 48hrs post-exposure<ref>Colwell CB: Radiation injuries, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 146: pp 1945-1951.</ref>

Neil.m.young: Text replacement - "0 mg" to "0mg"

2016-07-19T06:23:07Z

Text replacement - "0 mg" to "0mg"

← Older revision		Revision as of 06:23, 19 July 2016
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	==Management==		==Management==
	*Aggressive supportive care is hallmark of ED management		*Aggressive supportive care is hallmark of ED management
	*Potassium iodide as thyroid protectant, at ~~130 mg~~ qd for adults, until radiation exposure ceases<ref>New York State Potassium Iodide (KI) and Radiation Emergencies: Fact Sheet. https://www.health.ny.gov/environmental/radiological/potassium_iodide/fact_sheet.htm.</ref>		*Potassium iodide as thyroid protectant, at 130mg qd for adults, until radiation exposure ceases<ref>New York State Potassium Iodide (KI) and Radiation Emergencies: Fact Sheet. https://www.health.ny.gov/environmental/radiological/potassium_iodide/fact_sheet.htm.</ref>

	==Disposition==		==Disposition==

ClaireLewis: /* Prodromal Stage */

2016-07-14T09:19:10Z

Prodromal Stage

← Older revision		Revision as of 09:19, 14 July 2016
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	*Characterized by nausea and vomiting		*Characterized by nausea and vomiting
	**Other symptoms include: malaise, fever, conjunctivitis		**Other symptoms include: malaise, fever, conjunctivitis
	**Doses over 1000 rad (10 Gy), vomiting is not seen in early ~~sxymptoms~~		**Doses over 1000 rad (10 Gy), vomiting is not seen in early symptoms
	*Occurs within 48h-6d of exposure (at higher doses, can begin within minutes)		*Occurs within 48h-6d of exposure (at higher doses, can begin within minutes)
	*Lasts up to 2 days		*Lasts up to 2 days

← Older revision		Revision as of 02:42, 22 June 2018
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	*[[Radiation exposure (disaster)]]		*[[Radiation exposure (disaster)]]
	*[[Disaster medicine]]		*[[Disaster medicine]]

			==External Links==
			*[https://emergency.cdc.gov/radiation/arsphysicianfactsheet.asp]

	==References==		==References==