Pediatric emergency medicine trisk 1990 1990
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wrapping the contaminated area until it can be cleaned. Because it is much easier
to detect radioactive contamination than chemical or biologic hazards, cleanup
following a radiation accident will be much more effective.
External contamination is rarely a significant medical problem, but
decontamination requires preplanning. Externally contaminated patients should
be admitted through a separate entrance of the ED. If this is not possible, then
patients should be placed on a clean stretcher outside the ED and wrapped in a
cloth (not plastic) sheet and then transported to the desired area of the hospital.
Access to the treatment area should be controlled.
TABLE 90.17
DECONTAMINATION
Remove clothes
Wash with a damp cloth
Pay special attention to skin folds and
fingernails
Cover clean wounds to prevent
contamination
Prevent external and tepid water
contamination from becoming
internal
Do not abrade the skin
Removal of the patient’s clothing will eliminate up to 90% of the external
contamination ( Table 90.17 ). Contaminated articles should be placed in labeled
plastic bags. Residual contamination is likely to be on the hands, face, hair, and
wounds. These should be washed with lukewarm water and soap. Cleaning the
skin with damp washcloths is better than cleaning with running water. The
radioactive dirt on the damp washcloth can be contained by placing the cloth in a
plastic bag. Radioactive dirt in wash water is much more difficult to control.
Shaving should not be performed because this may make small cuts and increase
absorption through the skin. Excessive rubbing of the skin may also increase
transdermal uptake.
Open uncontaminated wounds should be covered to prevent them from
becoming contaminated. Contaminated wounds should be cleaned like any other
dirty wound. All samples from the patient should be saved and labeled if there is
any question about the identity of the radionuclides.
A Geiger counter should be used to monitor and document the progress of the
decontamination efforts. If contamination persists, the source may be fixed to the
skin or may be internal. Radiation experts should be consulted before performing
