17.4 Medical Care for Admitted Patients
205
• Swab body orifices if external contamination is suspected
• Swab wounds or measure count rate from dressings if external contamination
is suspected
• 24-h urine collection for four days if internal contamination is suspected
• 24-h fecal collection for four days if internal contamination is suspected.
High levels of radiation exposure can cause additional complications such as
skin burns, blistering, hair loss, and so forth; in general these are unlikely to appear
within a few to several days after exposure and they can usually be treated by treating
the symptoms. This is discussed in greater detail in the following section. Medical
caregivers will also need to take appropriate radiation safety precautions to protect
themselves and others under their care; these are also discussed below.
17.4.2 Addressing Radiological Health Concerns
Radiological health effects all depend on the amount of radiation exposure a person
has received; deterministic health effects depend on the acute radiation exposure and
stochastic health effects are a function of radiation exposure over a lifetime. Therefore, an estimate of a patient’s radiation exposure from both internal and external
radioactivity is important to know or to estimate. If it can be determined that a patient
has less than 1 CDG of internal contamination and external exposure is estimated to
have been less than 0.25 Sv then it is likely that radiation exposure will have little or
no impact on a patient’s clinical presentation. At higher levels of exposure, the radiation exposure becomes increasingly important; at exposures (internal and external
combined) of about 3 Sv, not only does the radiation begin to cause short-term health
effects (e.g. skin burns) but it can also be fatal to some of those exposed.
The progression of symptoms in admitted patients can help physicians to determine the likely radiation exposure and the patient’s future prognosis. Table 17.2 lists
a number of symptoms and their time to onset among acutely exposed patients (from
[11, 15]).
Some of the deterministic effects can be treated symptomatically. The author had
the opportunity to meet the physician who treated the skin burns of two Fukushima
workers whose boots filled with radioactive water while they were inspecting the
basement of a building following the accident. The physician mentioned that the two
workers had second-degree burns over their lower legs, and that he treated these the
same as any other second-degree burns; the fact that they were caused by radiation
did not affect his treatment plans. It must be noted that erythema, epilation, blistering,
ulceration, and necrosis are all injuries that require doses of 3 Gy or more to the skin
and that these do not manifest themselves for at least 2 weeks post-exposure. Thus,
any burns that are seen in the Emergency Department on the day of a radiological
attack are likely to be due to thermal, chemical, or even electrical damage to the skin
and not due to radiation.
205
• Swab body orifices if external contamination is suspected
• Swab wounds or measure count rate from dressings if external contamination
is suspected
• 24-h urine collection for four days if internal contamination is suspected
• 24-h fecal collection for four days if internal contamination is suspected.
High levels of radiation exposure can cause additional complications such as
skin burns, blistering, hair loss, and so forth; in general these are unlikely to appear
within a few to several days after exposure and they can usually be treated by treating
the symptoms. This is discussed in greater detail in the following section. Medical
caregivers will also need to take appropriate radiation safety precautions to protect
themselves and others under their care; these are also discussed below.
17.4.2 Addressing Radiological Health Concerns
Radiological health effects all depend on the amount of radiation exposure a person
has received; deterministic health effects depend on the acute radiation exposure and
stochastic health effects are a function of radiation exposure over a lifetime. Therefore, an estimate of a patient’s radiation exposure from both internal and external
radioactivity is important to know or to estimate. If it can be determined that a patient
has less than 1 CDG of internal contamination and external exposure is estimated to
have been less than 0.25 Sv then it is likely that radiation exposure will have little or
no impact on a patient’s clinical presentation. At higher levels of exposure, the radiation exposure becomes increasingly important; at exposures (internal and external
combined) of about 3 Sv, not only does the radiation begin to cause short-term health
effects (e.g. skin burns) but it can also be fatal to some of those exposed.
The progression of symptoms in admitted patients can help physicians to determine the likely radiation exposure and the patient’s future prognosis. Table 17.2 lists
a number of symptoms and their time to onset among acutely exposed patients (from
[11, 15]).
Some of the deterministic effects can be treated symptomatically. The author had
the opportunity to meet the physician who treated the skin burns of two Fukushima
workers whose boots filled with radioactive water while they were inspecting the
basement of a building following the accident. The physician mentioned that the two
workers had second-degree burns over their lower legs, and that he treated these the
same as any other second-degree burns; the fact that they were caused by radiation
did not affect his treatment plans. It must be noted that erythema, epilation, blistering,
ulceration, and necrosis are all injuries that require doses of 3 Gy or more to the skin
and that these do not manifest themselves for at least 2 weeks post-exposure. Thus,
any burns that are seen in the Emergency Department on the day of a radiological
attack are likely to be due to thermal, chemical, or even electrical damage to the skin
and not due to radiation.