1. Nuclear Emergency Medicine
Steven Podnos MD

2. Intial Steps
• Ensure Medical Stability (ACLS,ATLS)
• Decontamination
• Admit for Severe exposure, otherwise
outpatient management

3. Radiation is the transfer of energy
through space
• Ionizing particles:
• Beta Particles, low energy , few cm
penetration, short lived
• Alpha particles-stop at skin, only a problem if
internalized
• Gamma and Xrays are high energy, pass
through tissue, need lead to stop
• Neutron, (and Gamma) highly penetrating

4. Two types of clinical effects
• Stochastic: increased risk of cancer and
genetic mutations Not necessarily dose
related in terms of severity, but is related in
terms of likelihood of occurence
• Deterministic-dose related clinical effects-
hematologic suppression, cataracts, tissue
fibrosis, decreased fertility

5. Measuring Exposure
• One Rad=
• Rem=effect of absorbing one Rad
(approximate)
• Gy=100 Rads
• Sv

6. Types of Exposure
• Radiation-no contamination implied
• External Contamination
• Internal Contamination

7. Irradiation
• Use lymphocyte counts in nomogram to
calculate severity of exposure
• Lethal doses of radiation acutely are 2-400
rads (a head CT is one rad). Average annual
radiation exposure is 600mREM

8. Acute Radiation Syndrome
• Prodrome-Nausea, Vomiting, Abd pain, fever
• Latent-patient feels better, but not making
cells well
• Manifest Phase-skin, blood vessels, GI
mucosa, Bone Marrow deficiencies, Fibrosis
• Recovery or Death Phase-

9. Radiation from Nuclear Plant
Accidents
• Ionizing Radiation-Immediate and Residual
• Immediate Gamma Ray irradiation
• Residual induced radioactivity of soil, etc
• Fallout-immediate and delayed

10. Triage
• Onset of vomiting prodrome within 3 hours
suggests serious if not fatal dose. However,
must be differentiated from psychogenic
causes, so use lymphocyte depletion
nomogram