The Nuclear Incident
description
Transcript of The Nuclear Incident
![Page 1: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/1.jpg)
DPT 8.0
The Nuclear Incident
Management of Nuclear Casualties
![Page 2: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/2.jpg)
DPT 8.0
Hospital Management of Nuclear Casualties
![Page 3: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/3.jpg)
DPT 8.0
Terminal Objective
• Be able to describe the various types of radiological hazards.
• Become familiar with the acute health effects from radiation contamination and exposure.
• Become familiar with the principles of diagnosis, treatment and management of radiation casualties.
![Page 4: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/4.jpg)
DPT 8.0
Radiological and Nuclear Devices
• Simple radiological device
• Radiological dispersal device
• Reactor
• Improvised nuclear device
• Nuclear weapon
CONCEPTUAL DISPERSAL DEVICE
HIGH EXPLOSIV
E
SHIELDED CONTAINER
RADIOACTIVE MATERIAL
![Page 5: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/5.jpg)
DPT 8.0
The Basics of Radiation
Ionizing radiation is electromagnetic energy or energetic particles emitted from a source.
Ionizing radiation is able to strip electrons from atoms causing chemical changes in molecules.
![Page 6: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/6.jpg)
DPT 8.0
The Basics of Radiation
Chemical Damage
Free Radicals
10-10 Seconds
1. Proteins2. Membrane3. DNA
Biological Molecular Damage
Cells, tissues,whole animals
Hours to years
BiologicalDamage
Seconds to hours
![Page 7: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/7.jpg)
DPT 8.0
Ionizing Radiation - Alpha
• 2 neutrons and 2 protons
• Highly ionizing
• Travels several centimeters in air and a few microns in tissue
• Component of nuclear fallout
• Stopped by a thin paper or clothing
• Threat is inhalation or absorption of alpha emitter in wounds
![Page 8: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/8.jpg)
DPT 8.0
Ionizing Radiation - Beta
• High energy “electron” emitted from nucleus
• Can have wide range of energies depending upon the particular radionuclide
• Moderately penetrating
– Up to a few meters in air
– Millimeters in tissue
![Page 9: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/9.jpg)
DPT 8.0
Gamma or X-Ray (Photons)
• High energy rays
• Very penetrating
• Difficult to shield
• Can be produced from radioactive decay and a nuclear weapon explosion or reactor accident
![Page 10: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/10.jpg)
DPT 8.0
Ionizing Radiation - Neutrons
• Neutral particle emitted from the nucleus
• Can be very penetrating
• Requires special consideration for shielding
![Page 11: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/11.jpg)
DPT 8.0
Substance Half Life Emit Use
Americium 241 458 years , Smoke Detectors
Cobalt 60 5.3 years , Medical Therapy
Plutonium 238 86.4 years Thermoelectric Gen.
Plutonium 239 24,400 yrs Reactors and Weapons
Radium 226 1,602 yrs Medical Therapy
Uranium 238 millions yrs , Reactors and Weapons
Iridium 192 74 days , Industrial Radiography
Examples of Radioactive Materials
![Page 12: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/12.jpg)
DPT 8.0
Radiation Half-Life
• Time required for a radioactive substance to lose half of its radioactivity
• Each radionuclide has a unique half-life
• Half-lives range from extremely short (fraction of a second) to millions of years
Examples:Tc-99m 6.0 hrsI-131 8.05 daysCo-60 5.26 yrsSr-90 28.1 yrsPu-239 24,400 yrsU-238 4,150,000,000 yrs
![Page 13: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/13.jpg)
DPT 8.0
Radiation - Units of Measure
• rad - basic unit for measuring radiation
• rem - quantifies the amount of damage that is suspected from a particular type of radiation dose
![Page 14: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/14.jpg)
DPT 8.0
Radiation Doses in Perspective
Natural background and manmade radiation 360 mrem / yr
Diagnostic chest x-ray 10 mrem
Flight from LA to Paris 4.8 mrem
Barium enema 800 mrem
Smoking 1.5 ppd 16,000 mrem / yr
Heart catheterization 45,000 mrem
Mild acute radiation sickness 200,000 mrem
LD50 for irradiation 450,000 mrem
mrem = millirem = 1/1000 of a rem
![Page 15: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/15.jpg)
DPT 8.0
Types of Radiation Exposure
• External irradiation - whole-body or partial-body
• Contamination by radioactive materials - external (deposited on the skin) or internal (inhaled, swallowed, absorbed through skin, or introduced through wounds)
• Incorporation of radioactive materials - uptake by body cells, tissues, or organs (bone, liver, kidney, etc)
• Combined radiation injury - combination of the above complicated by trauma.
![Page 16: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/16.jpg)
DPT 8.0
Radiation Injury - External Irradiation
s
Local PartialBody
WholeBody
![Page 17: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/17.jpg)
DPT 8.0
Radiation Injury - Contamination
InternalExternal
![Page 18: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/18.jpg)
DPT 8.0
Radiation Injury - Incorporation
ThyroidLung
LiverBone
![Page 19: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/19.jpg)
DPT 8.0
Radiation - LD50
• We know what radiations are produced
• We know how to measure them
• But the body senses cannot detect radiation. Therefore, how can we measure the biological damage?
– LD50/30 Animals
– LD50/60 Human
![Page 20: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/20.jpg)
DPT 8.0
Examples of LD50 for Given Species
Species Dose (rads)
• Guinea Pigs 250 LD 50/30
• Goat 350 LD 50/30
• Man 250-450 (LD 50/60)
• Mouse 570 LD 50/30
• Rat 550-800 LD 50/30
• Frog 700 LD 50/30
• Snail 8,000-20,000 LD 50/30
![Page 21: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/21.jpg)
DPT 8.0
Severity of Injury
The higher the dose, the more severe the early effects and the greater the possibility of delayed
effects
![Page 22: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/22.jpg)
DPT 8.0
Acute Radiation Syndrome (ARS)
• Group of symptoms that develop after total body irradiation (> 100 rads)
• May occur from either internal or external radiation
• Four important factors are:– High Dose
– High Dose Rate
– Whole Body Exposure
– Penetrating Radiation
![Page 23: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/23.jpg)
DPT 8.0
ARS - Phases
• Prodromal Phase - occurs in the first 48 to 72 fours post-exposure and is characterized by nausea, vomiting, and anorexia. At doses below about 500 rads last 2 to 4 days.
• Latent Phase - follows the prodromal phase and lasts for approximately 2 to 2 1/2 weeks. During this time, critical cell populations (leukocytes, platelets) are decreasing as a result of bone marrow insult. The time interval decreases as the dose increases.
• Illness Phase - period when overt illness develops
• Recovery or Death Phase - may take weeks or months
![Page 24: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/24.jpg)
DPT 8.0
ARS - Hematopoitic SystemBlood Count
24-hr 1 week 2 weeks 3 weeks
Lymphocytes
Neutrophils
Platelets
RBC
Cell Reduction
![Page 25: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/25.jpg)
DPT 8.0
ARS - Hematopoietic Syndrome
3.0
2.5
2.0
1.5
1.0
0.5
0.10 3 6 17 24 48 hrs
Normal Range
Moderate
Severe
Very SevereLethal
Injury
Abs
olut
e Ly
mph
ocyt
es (
109/L
)
Patient
![Page 26: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/26.jpg)
DPT 8.0
ARS - Gastrointestinal Syndrome
• Radiation > 600 rads
• Damages intestinal lining
• Nausea and vomiting within the first 2 - 4 hours
• May develop diarrhea
• Associated with sepsis and opportunistic infections
• At 10 days could develop bloody diarrhea resulting in death
![Page 27: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/27.jpg)
DPT 8.0
ARS - Central Nervous System
• Seen with radiation dose > 1,000 rads
• Microvascular leaks edema
• Elevated intracranial pressure
• Death within hours
![Page 28: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/28.jpg)
DPT 8.0
ARS - Skin
ResponseE
pila
tion
Ery
them
a
Dry
Des
quam
atio
n
Moi
stD
esqu
amat
ion
Nec
rosi
s
300 600 1000 >1500 >5000
Dose
![Page 29: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/29.jpg)
DPT 8.0
ARS & Trauma
• Radiation and Trauma = Mortality
• Trauma is the first priority
![Page 30: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/30.jpg)
DPT 8.0
Treatment
• Wound and burn care, surgery, and orthopedic repair should be done in the first 48 hours or delayed for 2 to 3 months
24 - 48 Hours 3 Months
EmergencySurgery
Hemopoietic RecoveryNo Surgery
After 3 Months
SurgeryPermitted
![Page 31: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/31.jpg)
DPT 8.0
Survival Time
200 Rads 1000 Rads 100,000 Rads
Hematopoietic
Gastrointestinal
CNS/ CVS
SurvivalTime
![Page 32: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/32.jpg)
DPT 8.0
Classification, Treatment & Disposition
• Patients are classified in three categories based
on signs and symptoms:
– Survival probable < 100 rads
– Survival possible 200 - 800 rads
– Survival improbable > 800 rads
![Page 33: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/33.jpg)
DPT 8.0
Classification, Treatment & Disposition Incorporation / Internal Contamination
• Various medications can be used to limit uptake or facilitate removal of radioactive material
• Numerous medications are approved by the FDA. Certain drugs are investigational and can be used in an emergency (i.e. Radiogardase [Prussian Blue] and DTPA)
• NCRP 65
![Page 34: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/34.jpg)
DPT 8.0
Radiation Protection Principles
• Time
• Distance
• Shielding
![Page 35: The Nuclear Incident](https://reader035.fdocuments.in/reader035/viewer/2022070412/568149d5550346895db6fc3e/html5/thumbnails/35.jpg)
DPT 8.0
Key Points
• No antidote for radiation exposure - treatment is primarily supportive
• Minimal risk to responding personnel from radiation contaminated patients
• Early symptoms are an indication of the severity of the radiation dose
• Consult with specialists for “survivable groups”
• Treat life-threatening injuries first