Tasty Morsels of EM 088 – #FRCEM Radiation incidents

27 Jul

I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.

You can find more things on the FRCEM on this site here.

Be sure to read the prior post that fits with this one.

There’s also a prior post on the site from ages ago. 

And there’s a couple of FOAMed sites too

Types of Exposure

  • someone exposed to radiation eg xrays or gamma rays and now removed from site of exposure poses no exposure risk to anyone else
  • someone contaminated with radioactive material (eg Homer leaving the power plant in the original Simpsons intro) poses an ongoing risk and needs detailed decontamination

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clinical features

  • clinical features
    • early (within a few hours)
      • malaise
      • GI symptoms
      • time to emesis from exposure has some prognostic value (eg within 2 hrs indicates possible lethal dose)
    • latent period
      • perhaps a few days without symptoms
    • late
      • haematological collapse
      • GI collapse
      • neurological syndrome (almost universally fatal)

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How would you manage a patient and what is the prognosis?

  • our role is largely decontamination and supportive
  • check the absolute lymphocyte count as that’s one of the most useful prognostic things to trend
  • a bone marrow transplant has been helpful in the haematological syndrome but as yet ha not been included in FRCEM OSCEs…
  • Prognosis
    • >2 Gy: Oh crap but you’ll hopefully be OK
    • >10 Gy: switch off the lights on your way out…

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