Medical Management of the Acute Radiation Syndrome: Recommendations of the Strategic National Stockpile Radiation Working Group

View larger version (25K): [in a new window]   Figure 1. Approximate time course of clinical manifestations. Shown are approximate times for hematopoietic, gastrointestinal (GI), and central nervous system (CNS) symptoms at different ranges of dose of whole-body radiation for exposed, living persons. Hematopoietic changes include development of lymphopenia, granulocytopenia, or thrombocytopenia. Gastrointestinal symptoms include headache, nausea, vomiting, or diarrhea. Cerebrovascular signs and symptoms include headache, impaired cognition, disorientation, ataxia, seizures, prostration, and hypotension. Note that the signs and symptoms of different organ systems significantly overlap at each radiation dose and that cerebrovascular symptoms do not appear until exposure to a high whole-body dose. The relative severity of signs and symptoms is measured on an arbitrary scale. Prepared from data in reference 16.

View larger version (26K): [in a new window]   Figure 2. Approach to triage and therapy for persons exposed to radiation in a limited-casualty scenario. A numeric degree of severity is assigned for the cutaneous, gastrointestinal (GI), neurovascular, and hematopoietic systems, as defined in Tables 2 and 3. The highest degree of toxicity to an organ system indicates the physiologic "response category" (that is, 1, 2, 3, or 4). Modified with permission from reference 24.

View larger version (35K): [in a new window]   Appendix Figure 1. Summary of a medical record of a patient injured in a radiation accident. Shown are the absolute leukocyte count (top left panel), estimated organ dose (top right panel), areas of skin injury (middle panels), injury to oral cavity and gastrointestinal system (bottom left panel), and body position relative to the radioactive source (bottom right panel) as a function of time after the exposure. To convert cells/mm3 to x109 cells/L, multiply by 0.001. Redrawn with permission from reference 29.

View larger version (30K): [in a new window]   Appendix Figure 2. Leukocyte count based on exposure dose in patients exposed to radiation in Chernobyl. Note the abortive rise (transient increase before the fall) in counts of leukocytes, which are primarily composed of granulocytes, in doses less than 5 Gy. Neutropenia may not occur for weeks, especially with lower exposures, and its duration may be prolonged. To convert cells/mm3 to x109 cells/L, multiply by 0.001. Redrawn with permission from reference 36.