Chapter 142

#### High-Yield Facts

• Ionizing radiation is more dangerous than nonionizing radiation because such reactions lead to breaks in both DNA and RNA.

• There are two categories of radiation injuries with which the emergency physician should be familiar:

• Exposure injury, which generally represents no threat to emergency care providers.

• Contamination, which may represent a risk to emergency personnel.

• Acute radiation syndrome may develop following a whole-body exposure of 100 rad or more that occurs over a relatively short period of time.

• In the presence of contamination, if the patient's condition permits, decontamination should begin in the prehospital setting.

Radiation accidents involving discarded medical and industrial sources get little attention compared to problems at nuclear power plants or weapon facilities. Unfortunately, these accidents occur around the world with surprising regularity and, in some instances, prove deadly.

According to the Radiation Emergency Assistance Center/Training Site (REAC/TS) Radiation Accident Registry, between 1944 and 2007, there have been 432 accidents worldwide. These accidents resulted in significant radiation exposure to 3082 individuals and in 127 deaths (Table 142-1).

TABLE 142-1Major Radiation Accidents: Human Experience—1944 to June 2007

Despite the relatively rare incidence of medically significant pediatric radiation accidents, our dependence on nuclear energy makes it necessary for today's emergency physician to understand its potential for disaster. Most obvious are the threats of sophisticated nuclear weaponry to individuals of all ages. A more probable predicament, however, is an isolated or limited exposure in a medical, industrial, or research accident, or during the transport of radionucleotides. Basic preparation for radiation emergencies is not difficult, but a thorough understanding of the pathophysiology and clinical presentation is necessary in order to successfully handle all aspects of these complex problems.

All individuals are susceptible to radiation injury if the exposure is of significant dose and duration. Children, however, may suffer greater, short-, and long-term consequences of a significant radiation exposure for several reasons. Children are more susceptible to relatively greater internal exposure to inhaled radioactive gases given disproportionately higher minute ventilation.1 They are also at greater risk for developing subsequent malignancies when they are exposed to radiation.2,3 In the event of nuclear fallout, the short stature of children increases their exposure to a higher concentration of radioactive material on the ground.1 In addition, children are more likely ...

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