Medical Treatment of Radiological Casualties: Current Concepts

Abstract

The threat of radiologic or nuclear terrorism is increasing, yet many physicians are unfamiliar with basic treatment principles for radiologic casualties. Patients may present for care after a covert radiation exposure, requiring an elevated level of suspicion by the physician. Traditional medical and surgical triage criteria should always take precedence over radiation exposure management or decontamination. External contamination from a radioactive cloud is easily evaluated using a simple Geiger-Muller counter and decontamination accomplished by prompt removal of clothing and traditional showering. Management of surgical conditions in the presence of persistent radioactive contamination should be dealt with in a conventional manner with health physics guidance. To be most effective in the medical management of a terrorist event involving high-level radiation, physicians should understand basic manifestations of the acute radiation syndrome, the available medical countermeasures, and the psychosocial implications of radiation incidents. Health policy considerations include stockpiling strategies, effective use of risk communications, and decisionmaking for shelter-in-place versus evacuation after a radiologic incident.

Multiplacenta derived stem cell/cytokine treatment increases survival time in a mouse model with radiation-induced bone marrow damage

“…Nuclear events, radiological terrorism, and radiation accidents result in a large number of patients with radiation-induced bone marrow damage Koenig et al 2005;Pellmar and Rockwell 2005;Mettler and Voelz 2002). It is a refractory disease that has a high fatality rate with pancytopenia.…”

Overview of Radiation-protective Agent Research and Prospects for the Future

“…9) Numerous candidate for radiation countermeasures (specifically radioprotectants and radiomitigators) have been identi ed and have been or are currently being developed for the U.S. Food and Drug Administration (FDA) approval. [13][14][15][16] …”

Development and Evaluation of Therapeutics in the Setting of Radiation Injury

“…Symptoms of moderate Hem-ARS is due to exposure to levels of ionizing radiation greater than 1-2 Gray, and manifests as bone marrow damage (Figure 1-3) [3]. Severe Hem-ARS is seen at ionizing radiation doses from 4 Gy [2,4]. It is estimated that without supportive care (antibiotics and transfusions), a radiation dose of approximately 3.5-4.5 Gy will result in death of 50% of persons exposed within 60 days (LD 50/60 ) [3,5,6].…”

“…ARS encompasses overlapping syndromes including hematopoietic (Hem-ARS), gastrointestinal, and neurological syndromes (Figure 1-1). Victims whose TBI dose ranges from 2-6 Gy, known as the hematopoietic syndrome, will be most likely to be saved with treatment, and it is estimated that nearly all persons exposed to doses greater than 6 Gy will die within 30 days of exposure if not treated [2].…”

“…The result of the damage to the intestine is decreased barrier function and abnormal absorption. Clinical symptoms of GI-ARS include nausea, vomiting, and diarrhea in addition to those of the hematopoietic syndrome, impaired immune function being of particular importance [2]. Since ARS sub-syndromes overlap, patients faced with the GI syndrome are still highly susceptible to hemorrhage and infections due to a depressed immune system.…”