Title: COMBINED RADIATION INJURIES
1COMBINED RADIATION INJURIES
2Effects 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
3Combined 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
4Classification 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
5Predicted 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
6Distinctive 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
7Phases (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
8Burns and radiation
Boy was 1.5 km from the detonation of the
Nagasaki atomic bomb
9Radiation and burns
Radiation burns on Japanese atomic bomb victim
10Sytemic response to burn injury
- After adequate resuscitation hyperdynamic
state - increased cardiac output
- diuresis
- peripheral catabolism
- Early period
- shock with hypovolemia
- gastrointestinal ileus
- oligouria
11Causes of burn deaths
- Direct results of accident 13
- Sepsis
45 - Organ /system failure
- (burn shock, acute renal failure) 41
- Yatrogenic intervention 1
12Expected mortality from thermal injuries
13Combined effects of simultaneous whole body
irradiation and burns
14Principles of burn therapy
- Topical antimicrobials
- Early grafting
- Stimulation of the bone marrow and possibly of
skin regeneration with cytokines
15Initial surgery
Complete graft healing after 8 days
Major skin necrosis on both legs, extending to
subcutaneous tissue
Epifascial excision of necrotic skin
16Treatment of contaminated burn injuries
- Gentle decontamination after stabilization
- Passive tetanus immunization even in previously
immunized patients
17Classification of Chernobyl victims
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18Chernobyl 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
19Wounds and radiation
20Trauma repair
21Effects 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
22Immunosuppressive effect
- Bone marrow suppression
- Consumption of inflamatory reserves
- Disruption of epidermal barriers
- Depression of reticuloendothelial system
23Principles of treatment
- Control haemorrhage
- Examine and remove all questionable tissue and
foreign material - Repair vital structures
- Irrigate
- Consider wound closure
24Problems of wound treatment
- Wound colonization
- Wound sepsis
- Failed delayed primary closure
- Delay in healing
- Occasional amputation
- Radioactive nuclides contaminated wound
25Timing of surgical management
26Hiroshima 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
27Medical management
- Triage
- Emergency care
- Definitive care
28Triage
- 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
29Emergency procedures
- First actions standard emergency medical
procedures - ventilation
- circulation
- stop haemorrhage
- Decontamination after stabilization
- Survivable radiation injury not acutely life
threatening
30Secondary 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
31Prognosis
- Prognosis for all combined injuries worse than
for radiation injury alone - Infections much more difficult to control
- Burns, wounds and fractures heal more slowly
32Summary 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
33Lecture is ended
THANKS FOR ATTENTION
In lecture materials of the International Atomic
Energy Agency (IAEA), kindly given by doctor
Elena Buglova, were used