Radiation

Question 1

Radiation dose of:
- 1 year background
- CXR
- CTB
- CT abdo

Answer 1

• 1 year background 3mSv
• CXR 0.01
• CTB 8
• CT abdo 10

Question 2

What 2 ways can someone be harmed by radiation?

Answer 2

Exposure to ionising radiation

Contamination with radioactive material (requires wash decontam)

Question 3

Phases of Acute radiation illness

Answer 3

Prodromal (48hrs)
- Non spec: N&V, weakness, headache, flush, conjunctivitis.
- From vasoactive amine release
Latent (hours to weeks)
- Shorter = worse prog
Manifest Illness
- *Pancytopaenia 1-4 Gy, prognosis good.
- GI. 6+ Gy. Poorer prog. Bloody diarrhoea.
- Neuro 20+ Gy. Death in hours.
Death or Recovery (over 2-3 months)

Question 4

How are radiation victims triaged?

Answer 4

Symptoms
- Vomiting already: urgent.
- Neuro: goners
AND
Lymphocyte count
- Lymphopaenic at 6 hours, goners.

If not vomiting at 6 hours, can be managed as outpatient (await manifest)

Question 5

Treatment of acute radiation illness:

Answer 5

• Analgesia, antiemetic
• Fluid + electrolyte replacement, blood if big PR losses
• Nutrition
• GCSF, BM transplant, transfusions
• Broad antibiotics (antifungals/virals dep on severity of neutropaenia)

Always treat life threats first: decontam and radiation injury can wait- it’s slower

Question 6

How to decontaminate in contamination with radioactive substance:

Answer 6

EXTERNAL decontam:
- Clothes off and bag
- Wash- prioritise orifices- lead to internal contam
- Swab mucosa (?rad ?chemical)

Stand back unless directly involved
PPE and dosimeters
Rotate staff
Nil pregnant staff
Staff shower after ‘turn’

Chelating agents (consider)

Question 7

Do staff need to wear PPE?

Answer 7

Yes if patient externally or internally contaminated with radioactive substance

No (universal only) if just victim of ionising radiation: NO THREAT TO STAFF