Advanced Trauma Life Support ATLS Student Course Manual 2018

298
APPENDIX D n Disaster Preparedness and Response
tissue, irradiating casualties but leaving no
radioactivity behind.
2. Particle radiation (alpha and beta particles)—
Does not easily penetrate tissue. (The amount of
radiation absorbed by cells is measured in Grays
(Gy) or new international standard of radiation
dose the rad 1 Gy = 100 rad.)
Radiation exposure can consist of external
contamination, localized or whole body, or internal
contamination. With external contamination,
radioactive debris is deposited on the body and
clothing. With internal contamination, radioactive
debris is inhaled, ingested or absorbed. Assume both
external and internal contamination when responding
to disasters involving radioactive agents.
Emergency Management of Radiation Victims
The medical effects of radiation include focal tissue
damage and necrosis, acute radiation syndrome (ARS,
n BOX D-5), and long-term effects that can persist for
box d-5 acute radiation syndrome
(ars)
• Group of clinical sub-syndromes that develop acutely
(within several seconds to several days) after exposure
to penetrating ionizing radiation above whole-body
doses of 1 Gy (100 rads).
• ARS affects different systems, depending on the total
dose of radiation received.
• Lower doses predominantly damage the hematopoietic
system.
• Increasing doses damage the gastrointestinal system,
the cardiovascular system, and the central nervous
system, in that order.
• The higher the exposure, the earlier symptoms will
appear and the worse the prognosis.
Prodromal Phase
• Symptoms—nausea, vomiting, diarrhea, fatigue
Latent Phase
• Length of phase variable depending on the exposure
level
• Symptoms and signs—relatively asymptomatic, fatigue,
bone marrow depression
• A reduced lymphocyte count can occur within 48 hours
and is a clinical indicator of the radiation severity.
Manifest Illness
• Symptoms—Clinical symptoms associated with major
organ system injury (marrow, intestinal, neurovascular)
Death or Recovery
weeks to decades, such as thyroid cancer, leukemia,
and cataracts.
Principles of the emergency management of radiation
victims include:
••
Adhere to conventional trauma triage
principles, because radiation effects
are delayed.
••
Perform decontamination before, during, or
after initial stabilization, depending on the
severity of injury.
••
Recognize that radiation detectors have specific
limitations, and many detectors measure only
beta and gamma radiation.
••
Emergency surgery and closure of surgical
wounds should be performed early in victims of
radiation exposure.
••
Nuclear reactors contain a specific mixture
of radioactive elements. Iodine tablets are
effective only against the effects of radioactive
iodine on the thyroid.
n BOX D-6 outlines key features of several radiation
threat scenarios.
box d-6 radiation threat scenarios
Nuclear Detonations
Three types of injuries result from nuclear detonations:
• Blast injuries—overpressure waves
• Thermal injuries—flash and flame burns
• Radiation injuries—irradiation by gamma waves and
neutrons and radioactive debris (fallout)
Meltdown of a Nuclear Reactor
• Core must overheat, causing nuclear fuel to melt
• Containment failure must occur, releasing radioactive
materials into environment
Radiation Dispersal Device (dirty bomb)
• Conventional explosive designed to spread radioactive
material
• No nuclear explosion
Simple Radiological Dispersion
• Simple radioactive device that emits radioactivity
without an explosion
Pitfalls
The four common pitfalls in disaster medical response
are always the same—security, communications, triage
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