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COMBINED RADIATION INJURIES

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Chernobyl nuclear reactor accident on 26 April 1986 ... Epifascial excision of necrotic skin. Complete. graft healing after 8 days ... – PowerPoint PPT presentation

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Title: COMBINED RADIATION INJURIES


1
COMBINED RADIATION INJURIES
2
Effects of nuclear weapons and nuclear accident
The detonation of atomic bombs over Hiroshima and
Nagasaki on 6 9 August 1945
Chernobyl nuclear reactor accident on 26 April
1986
3
Combined radiation injuries
  • Combined radiation injuries is the kind of
    defeats arising at simultaneous or consecutive
    influence on an organism of ionizing radiation
    and non-radiation factors

4
Classification of combined radiation injures
  • According to radiation dose combined with other
    factors, combined radiation injures (CRI) can be
    classified as
  • thermal CRI external/internal irradiation with
    thermal burns
  • mechanical CRI external/internal irradiation
    with wound or fracture, or haemorrhage
  • thermal-mechanical CRI external/internal
    irradiation with thermal burns and wound
    (fracture, haemorrhage)
  • chemical CRI external/internal irradiation with
    chemical burns or chemical intoxication

5
Predicted distribution of injuries from nuclear
explosion
  • Single injuries 30 to 40
  • Ionizing radiation 15 to 20
  • Burns 15 to 20
  • Wounds Up to 5
  • Combined injuries 65 to 70
  • Irradiation, burns, wounds 20
  • Irradiation, burns 40
  • Irradiation, wounds 5
  • Wounds, burns 5

6
Distinctive features of combined radiation
injures
  • Presence at the victim of attributes two or more
    pathologies
  • Prevalence of one, heavier and expressed during
    the concrete moment of pathological process,
    so-called a leading component
  • Interference (mutual burdening) radiation and
    non-radiation factors, shown as heavier current
    of pathological process, than it is peculiar to
    each component

7
Phases (periods)of combined radiation injuries
  • The acute phase or the period of primary
    reactions to radiation
  • and non-radiation traumas
  • The period of prevalence of non-radiation
    components
  • The period of prevalence of radiation components
  • The recovery phase or the period of restoration

8
Burns and radiation
Boy was 1.5 km from the detonation of the
Nagasaki atomic bomb
9
Radiation and burns
Radiation burns on Japanese atomic bomb victim
10
Sytemic response to burn injury
  • After adequate resuscitation hyperdynamic
    state
  • increased cardiac output
  • diuresis
  • peripheral catabolism
  • Early period
  • shock with hypovolemia
  • gastrointestinal ileus
  • oligouria

11
Causes of burn deaths
  • Direct results of accident 13
  • Sepsis
    45
  • Organ /system failure
  • (burn shock, acute renal failure) 41
  • Yatrogenic intervention 1

12
Expected mortality from thermal injuries
13
Combined effects of simultaneous whole body
irradiation and burns
14
Principles of burn therapy
  • Topical antimicrobials
  • Early grafting
  • Stimulation of the bone marrow and possibly of
    skin regeneration with cytokines

15
Initial surgery
Complete graft healing after 8 days
Major skin necrosis on both legs, extending to
subcutaneous tissue
Epifascial excision of necrotic skin
16
Treatment of contaminated burn injuries
  • Gentle decontamination after stabilization
  • Passive tetanus immunization even in previously
    immunized patients

17
Classification of Chernobyl victims
 
18
Chernobyl conclusions
  • Radiation burns frequent
  • Burns over 50 of body surface led to death in
    19 out of 28 cases
  • Internal contamination was present in most of
    patients, however, it was significant just in a
    few cases
  • Sepsis uniform cause of death
  • Bone marrow transplantation is very limited
    indications
  • Some radiation burns did not reepithelialize and
    required surgery

19
Wounds and radiation
20
Trauma repair
21
Effects of persistent pancytopenia
  • Decreased oxygen capacity
  • Lack of release of new erythrocytes and aging of
    red cell population
  • Decreased clotting ability
  • Megakaryocytes unable to replicate, plateletes
    consumed
  • Altered wound healing
  • Fibroblasts damaged by irradiation do not
    replicate at normal rate
  • Immunosuppression

22
Immunosuppressive effect
  • Bone marrow suppression
  • Consumption of inflamatory reserves
  • Disruption of epidermal barriers
  • Depression of reticuloendothelial system

23
Principles of treatment
  • Control haemorrhage
  • Examine and remove all questionable tissue and
    foreign material
  • Repair vital structures
  • Irrigate
  • Consider wound closure

24
Problems of wound treatment
  • Wound colonization
  • Wound sepsis
  • Failed delayed primary closure
  • Delay in healing
  • Occasional amputation
  • Radioactive nuclides contaminated wound

25
Timing of surgical management
26
Hiroshima and Nagasaki conclusions
  • Complications developed 2 to 3 weeks after
    exposure characteristic of bone marrow depression
    effects
  • Open wounds stopped healing, haemorrhaged
  • Many patients died of sepsis

27
Medical management
  • Triage
  • Emergency care
  • Definitive care

28
Triage
  • In radiation accident or nuclear detonation, many
    patients can suffer from burns and traumatic
    injuries in addition to radiation
  • Initial triage of combined injury patients based
    on conventional injuries
  • Treat associated injuries first

29
Emergency procedures
  • First actions standard emergency medical
    procedures
  • ventilation
  • circulation
  • stop haemorrhage
  • Decontamination after stabilization
  • Survivable radiation injury not acutely life
    threatening

30
Secondary assessment of combined injury
  • Primary surgical responsibilities
  • stabilize
  • set surgical priorities
  • perform surgery
  • Secondary responsibilities
  • manage post-operative course
  • assess radiation exposure in post-operative or
    post-stabilization period

31
Prognosis
  • Prognosis for all combined injuries worse than
    for radiation injury alone
  • Infections much more difficult to control
  • Burns, wounds and fractures heal more slowly

32
Summary of lecture
  • Diagnosis, treatment and prognosis are much more
    complex in combined radiation injures
  • Haematological indices and other laboratory tests
    can be modified in a way that makes diagnosis of
    radiation component difficult
  • Because radiation injury is not immediately life
    threatening, initial care should address
    emergency medical procedures for ventilation,
    perfusion and treatment of haemorrhage
  • Combined injury requires all urgent surgery to be
    completed within 48 hours of irradiation

33
Lecture is ended
THANKS FOR ATTENTION
In lecture materials of the International Atomic
Energy Agency (IAEA), kindly given by doctor
Elena Buglova, were used
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