Medical Management of the Acute Radiation Syndrome: Recommendations of the Strategic National Stockpile Radiation Working
Group
- Jamie K. Waselenko, MD;
- Thomas J. MacVittie, PhD;
- William F. Blakely, PhD;
- Nicki Pesik, MD;
- Albert L. Wiley, MD, PhD;
- William E. Dickerson, MD;
- Horace Tsu, MD;
- Dennis L. Confer, MD;
- C. Norman Coleman, MD;
- Thomas Seed, PhD;
- Patrick Lowry, MD;
- James O. Armitage, MD; and
- Nicholas Dainiak, MD
-
From Walter Reed Army Medical Center and Catholic University of America, Washington, DC; Greenebaum Cancer Center, University
of Maryland, Baltimore, Maryland; Armed Forces Radiobiology Research Institute and National Institutes of Health, Bethesda,
Maryland; Strategic National Stockpile Program, Centers for Disease Control and Prevention, Office of Emergency Preparedness
and Response, Atlanta, Georgia; Oak Ridge Associated Universities, Oak Ridge, Tennessee; National Marrow Donor Program, Minneapolis,
Minnesota; University of Nebraska, Omaha, Nebraska; and Yale-New Haven Health System and Yale University School of Medicine,
New Haven, Connecticut.
-
Figure 1. Shown are approximate times for hematopoietic, gastrointestinal ( ), and central nervous system ( ) 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 . Approximate time course of clinical manifestations.GICNS16
-
Figure 2. A numeric degree of severity is assigned for the cutaneous, gastrointestinal ( ), neurovascular, and hematopoietic
systems, as defined in Tables and . 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 . Approach to triage and therapy for persons exposed to radiation in a limited-casualty scenario.GI2324
-
Appendix Figure 1. Shown are the absolute leukocyte count ( ), estimated organ dose ( ), areas of skin injury ( ), injury
to oral cavity and gastrointestinal system ( ), and body position relative to the radioactive source ( ) as a function of
time after the exposure. To convert cells/mm to ×10 cells/L, multiply by 0.001. Redrawn with permission from reference . Summary of a medical record of a patient injured in a radiation accident.top left paneltop right panelmiddle panelsbottom
left panelbottom right panel3929
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Appendix Figure 2. 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/mm to ×10 cells/L, multiply by 0.001. Redrawn with permission from reference
. Leukocyte count based on exposure dose in patients exposed to radiation in Chernobyl.3936
Responses to this article
-
Ann Intern Med
June 15, 2004
vol. 140
no. 12
1037-1051
RSS Feeds
View larger version:Figure 1. Shown are approximate times for hematopoietic, gastrointestinal ( ), and central nervous system ( ) 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 . Approximate time course of clinical manifestations.GICNS16
View larger version:Figure 2. A numeric degree of severity is assigned for the cutaneous, gastrointestinal ( ), neurovascular, and hematopoietic systems, as defined in Tables and . 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 . Approach to triage and therapy for persons exposed to radiation in a limited-casualty scenario.GI2324
View larger version:Appendix Figure 1. Shown are the absolute leukocyte count ( ), estimated organ dose ( ), areas of skin injury ( ), injury to oral cavity and gastrointestinal system ( ), and body position relative to the radioactive source ( ) as a function of time after the exposure. To convert cells/mm to ×10 cells/L, multiply by 0.001. Redrawn with permission from reference . Summary of a medical record of a patient injured in a radiation accident.top left paneltop right panelmiddle panelsbottom left panelbottom right panel3929
View larger version:Appendix Figure 2. 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/mm to ×10 cells/L, multiply by 0.001. Redrawn with permission from reference . Leukocyte count based on exposure dose in patients exposed to radiation in Chernobyl.3936
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