Pediatric emergency medicine trisk 1984 1984
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the range of 100 Gy and at 3 weeks after dose levels of 30 to 50 Gy. Treatment is
required to prevent infection and to relieve pain. Skin grafting, especially
musculocutaneous flaps, may be appropriate if the radiation exposure was
localized and superficial. Progressive gangrene, due to the obliterative changes in
the small vessels, will occur if the radiation exposure is large and involves deep
structures. Under these circumstances, amputation may be necessary.
FIGURE 90.13 Effect of whole-body radiation on blood cell counts in the days after exposure.
Contamination
Contamination represents the other major type of radiation injury. Contamination
occurs when radioactive dirt or liquid remains on the patient (external
contamination) or, when inhaled or ingested, inside the patient (internal
contamination). Contamination is the only type of radiation injury that requires
the medical staff to take radiation-related precautions. Although there is usually
little danger to the medical staff when caring for a contaminated person once they
are in the hospital, medical personnel who respond to the accident site may be
exposed to large, potentially life-threatening doses of radiation. For these rescue
workers, 0.5 Gy is the voluntary limit suggested by the National Council on
Radiation Protection and Measurements (NCRP) for lifesaving activities.
External contamination. External contamination rarely is a significant
medical problem. To prevent additional radiation exposure to the patient, medical
staff, and the public, external contamination should be removed, and dispersal of
radioactive materials should be prevented. The goal of treatment of any
contaminated patient is to keep radiation exposures “as low as reasonably
achievable.” This is called the ALARA principle and requires advance planning,
specific supplies, and appropriate protective clothing. Preventing the dispersal of
