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Treatment of radiation injury in the adult

Authors
John R Wingard, MD
Nicholas Dainiak, MD, FACP
Section Editor
Robert S Negrin, MD
Deputy Editor
Alan G Rosmarin, MD

INTRODUCTION

The occurrence of industrial and medical radiation accidents and the threat of terrorist events involving radioactive material mandate the development and implementation of an appropriate medical response. Medical professionals who would logically be involved in such events include, among others, radiation safety officers, radiologists, radiation oncologists, nuclear medicine physicians, emergency department physicians, hematologists, medical oncologists, gastroenterologists, infectious disease specialists, as well as primary care providers. All will be asked to play a significant role in evaluating and treating victims of an accidental or deliberate exposure to radiation. Due to their experience in managing patients with cytopenias and/or marrow aplasia, hematologists will most likely be asked to take primary or consultative responsibility for medically treating individuals exposed to a moderate or high dose of radiation.

However, all physicians, and especially medical triage personnel, must have an understanding of how radiation alters the function of cells, tissues, and organ systems, how radiation levels are quantified, and how victims receiving a significant radiation dose can be recognized and categorized. These issues are discussed separately. (See "Biology and clinical features of radiation injury in adults".)

Scenarios have been developed for response to terrorist events resulting in small volume as well as mass casualties. The Strategic National Stockpile Radiation Working Group has developed a consensus opinion to provide guidance for estimating radiation dose, clinical assessment of exposed individuals, and medical management of those patients suffering from acute radiation injury [1]. Responding medical personnel must also be aware of local, state, and national resources that may be employed in the case of a radiation accident from whatever cause [2]. These subjects, as well as the treatment of patients with radiation injuries, will be discussed here.

Treatment of radiation accidents in children is covered separately. (See "Management of radiation exposure in children following a nuclear disaster".)

SCENARIOS FOR RADIATION ACCIDENTS

Excessive radiation doses may result from a number of different exposures, as described below:

                                                           

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