Pediatric emergency medicine trisk 1991 1991
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more aggressive decontamination. Some residual contamination may be
acceptable.
Exposure
Other than symptomatic measures, there is no immediate treatment to reverse
whole-body or local radiation exposure. Medically significant whole-body
radiation exposure is unlikely if the patient does not present with nausea and
vomiting. Serial CBCs (with special attention to the lymphocyte count) every
several hours are also helpful in excluding the diagnosis of a recent large wholebody exposure to radiation ( Table 90.18 ). In the absence of other major trauma,
the absolute lymphocyte count will rapidly fall in patients who have been exposed
to a large radiation dose. If a patient has been exposed to a large acute dose of
radiation, there is little in the way of specific medical treatment in the ED. The
threat to the patient’s life will occur within days to weeks after the exposure and
medical management includes prevention and treatment of infections, stimulation
of hematopoiesis with the use of growth factors, stem cell transfusions, or platelet
transfusions with severe thrombocytopenia. For any accident involving
radioactive materials, reports should be made to the appropriate state and federal
agencies.
The diagnosis of a local radiation injury requires vigilance. The physician
should consider the possibility of a local radiation injury whenever there is an
unexplained painless “burn” blister, ulceration, or necrosis of the skin. A CBC to
exclude an accompanying whole-body exposure and consultation with a radiation
expert is indicated. The prognosis of a local radiation injury depends on the dose.
The dose may be estimated by having a qualified physicist reconstruct the
accident that led to the exposure.
