Treatment of radiation injury
Last reviewed: 23.04.2024
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Ionizing effects can be accompanied by physical damage (for example, from an explosion or a fall); Concomitant injury can be more life threatening than radiation exposure and requires priority treatment. Assistance in case of serious injury should not be postponed until the arrival of radiation diagnostics and protection services. The standard precautions routinely used to help the injured are sufficient to protect rescuers.
Hospitalization
The certification service requires that all hospitals have protocols and that personnel are trained to work with radioactive contamination. When detecting radioactive contamination of the patient, it is isolated in a special room, disinfected and informed of the injured person in charge of the radiation safety of the clinic, health authorities, the hazardous materials service and law enforcement agencies, to actively search for the source of radioactivity.
Surfaces of contaminated areas of the body can be covered with a protective plastic screen, which facilitates decontamination in the future. This should never hamper the provision of medical care. Waste containers (labeled "Caution, radiation"), specimen containers and Geiger counters should be in constant readiness. All equipment that was in contact with the room or with the patient (including the ambulance equipment) must be isolated until a study is made of the degree of contamination.
Staff should wear caps, masks, gowns, gloves and shoe covers, and all open areas in protective clothing should be insulated with adhesive tape. The used material is placed in marked bags or containers. To monitor radiation contamination, personnel must wear individual dosimeters. To minimize exposure, personnel should be rotated. Participation of pregnant women in the treatment of patients is not allowed.
Decontamination
After isolation in a special room, the victim is carefully removed from clothing, which, in order to minimize the spread of contamination, must be placed in appropriate pre-prepared containers. With clothes, about 90% of external pollution is lost. The contaminated skin is washed with a warm mild soap solution until the level of radioactivity decreases to a two-fold background value or until successive rinses significantly reduce the level of contamination. During washing, all wounds on the body must be closed to prevent radioactive substances from entering them. Devices for cleaning the skin should be firm, but do not scrape off the skin. Particular attention is usually paid to the nails and skin folds. Special chelating-forming solutions containing ethylenediaminetetraacetic acid are not needed for decontamination.
Wounds are checked with a Geiger counter and rinsed until the radiation level is normalized. To remove particles stuck in the wound, it may be necessary to perform a surgical treatment. Removed from the wound, foreign bodies are placed in special lead containers.
The swallowed radioactive materials are removed as quickly as possible, causing vomiting or by washing the stomach if the irradiation has occurred recently.
If the mouth cavity is contaminated, rinse frequently with saline solution or dilute hydrogen peroxide. The contamination of the eyes is deactivated by a directed flow of water or a saline solution so as to avoid contamination of the nasolacrimal canal.
Other, more specific measures aimed at reducing internal pollution depend on the type of radionuclide and the results of compulsory specialist advice. If irradiation with radioactive iodine occurred (after an accident at a nuclear reactor or a nuclear explosion), the patient should be given potassium iodide (KI) as soon as possible; its effectiveness is significantly reduced within a few hours after irradiation. KI can be given either in tablets or as a saturated solution (dosing: adult 130 mg, aged 3-18 years 65 mg, aged 1-36 months 32 mg, under the age of 16 mg). Various chelating agents are used to treat internal contamination with other radioactive substances: saturated K (radioactive iodine), calcium diethylenetriamine pentaacetate or zinc (plutonium-239 or yttrium-90), Prussian blue (cesium-137, rubidium-82, thallium-201) or calcium preparations for oral administration or a solution of aluminum phosphate (radioactive strontium).
Decontamination is not indicated for patients who received radiation from external sources of radiation, without contamination.
[Specific treatment of radiation damage
If necessary, prescribe symptomatic treatment, including treatment of shock and anoxia, analgesics and anxiolytics, sedatives (lorazepam 1-2 mg intravenously) for the prevention of seizures, antiemetics (metoclopramide 10-20 mg intravenously every 4-6 h, prochlorperazine 5- 10 mg intravenously every 4-6 hours, ondansetron 4-8 mg intravenously every 8-12 hours), and antidiarrhoeic agents (kaolin + pectin 30-60 ml orally for each case of loose stool loperamide in the initial dose of 4 mg orally, then 2 mg orally every time a loose stool).
There is no specific cure for cerebral syndrome, the condition inevitably ends with death. The help consists in creation for the patient of the maximum comfort.
Gastrointestinal syndrome is treated with active replenishment of fluid and electrolytes. Parenteral nutrition allows to give unloading to the intestine. If the patient is feverish, the introduction of broad-spectrum antibiotics (eg imipenem + [cilastin] 500 mg intravenously every 6 hours) should be started immediately. Despite this, the shock of an incurable infection remains the most likely cause of death.
Treatment of hematological syndrome does not differ from that of bone marrow hypoplasia and pancytopenia of any etiology. For the treatment of anemia and thrombocytopenia, blood components are transfused, and hematopoietic growth factors (granulocyte colony stimulating factor and macrophage granulocyte colony-stimulating factor) and broad-spectrum antibiotics for the treatment of neutropenia and neutropenic fever, respectively, are introduced. Patients with neutropenia should be isolated. After irradiation with doses> 4 Gy, the probability of bone marrow restoration is extremely low, therefore the introduction of hematopoietic growth factors should be started as soon as possible. Stem cell transplants have had limited success, but they should be considered after irradiation with doses> 7-8 Gy (see the corresponding section).
In addition to regular monitoring of the symptoms of the disease (for example, eye examination for cataracts, thyroid function research), there are no specific monitoring or treatment methods for specific organ damage. Post-radiation cancer is treated in the same way as a spontaneous cancer of the Tazhelocalization.
Prevention of radiation injury
Protection from radiation exposure is to minimize the exposure time, maximum distance from the source and the use of protective screens. Protection from a known specific radioactive substance can be quite effective (in particular, with lead aprons or commercial transparent shields), but protection from radionuclide contamination from most major disasters (for example, a nuclear facility accident or explosion) can not be ensured. In this regard, after the radiation release, if possible, people in the contaminated zone should be evacuated for 1 week if the expected dose is> 0.05 Gy, and forever, if the predicted lifetime dose> 1 Gy. When evacuation is impossible, a shelter in a concrete or metal structure (for example, a basement) can provide some protection.
People living in the zone 16 km (10 miles) from the nuclear power plant, should have potassium iodide preparations in tablets. Access to their receipt should be provided both in pharmacies and in health care facilities. Many drugs and chemicals (eg, sulfhydryl formulations) increase survival in animals if the drugs are given before irradiation. However, none of them is effective to the same extent for people.
All personnel working with radioactive substances should wear dosimeters and regularly undergo tests for symptoms of excessive radiation exposure. The standard professional threshold is 0.05 Gy / year. For emergency medical personnel, the recommended dose thresholds are 0.05 Gy for any non-life-threatening events and 0.25 Gy for any life-threatening event.