1 / 33

COMBINED RADIATION INJURIES

COMBINED RADIATION INJURIES. Effects of nuclear weapons and nuclear accident. The detonation of atomic bombs over Hiroshima and Nagasaki on 6 & 9 August 1945. Chernobyl nucl e ar reactor accident on 26 April 1986. Combined radiation injuries.

wes
Download Presentation

COMBINED RADIATION INJURIES

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. COMBINED RADIATION INJURIES

  2. Effects of nuclear weapons and nuclear accident The detonation of atomic bombs over Hiroshima and Nagasaki on 6 & 9August 1945 Chernobyl nuclear reactor accident on 26 April 1986

  3. Combined radiation injuries • Combined radiation injuriesis the kind of defeats arising at simultaneous or consecutive influence on an organism of ionizing radiation and non-radiation factors

  4. Classificationof 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 ofinjuries from nuclear explosion • Single injuries 30% to 40% • Ionizing radiation15% 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 featuresof 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. Early period shock with hypovolemia gastrointestinal ileus oligouria After adequate resuscitation – hyperdynamic state: increased cardiac output diuresis peripheral catabolism Sytemic response to burn injury

  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. Radiation injury Dose, Gy Number of hospitalized patients Total Death Radiation burns Slight 1 – 2 140 0 0 Moderate 2 – 4 55 1 0 Severe 4 – 6 21 7 6 Extremely severe 6 – 10 21 20 20 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 oxygencapacity 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 • Complicationsdeveloped 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 EnergyAgency (IAEA), kindly given by doctor Elena Buglova, were used

More Related