Abstract
Recent world events and political tensions are again bringing attention to the possibility of a nuclear incident, including a detonation. Radiological materials are ubiquitous and are found in most cities throughout the country at academic institutions, hospitals, and many businesses and in industrial settings. Nuclear materials are more difficult to access because of their scarce nature and the security of the settings in which they are found. A significant radiological or nuclear (R/N) incident in the Unites States will require activation of local, state, territory, regional, and national government assets. Initially, ad hoc triage and treatment areas will rise up in the moderately to lightly damaged zones. Patients will undergo mass casualty triage and stabilization before medical evacuation to subsequent higher levels of care. This will require subject matter expert advice and response as the size and circumstances of the incident unfold. Initial mass casualty triage should be done to sort the populations who will require minor interventions, admission to the hospital, and possibly eventual intensive care and those who may have an extremely dire prognosis and may require comfort or hospice care. The hematologist-oncologist will be among those with the expertise to effectively treat those patients who will experience bone marrow aplasia as part of radiation exposure that is higher than 1-2 Gray (Gy). Acute radiation syndrome (ARS) is the complex of organ system injuries that occur from the radiation exposure. The organ systems show a classical clinical prodrome that correlates to radiation exposure dose. This syndrome will affect bone marrow, gastrointestinal, cutaneous, pulmonary, and neurovascular systems. These patients will require the expertise of intensivists and those experienced in managing systemic inflammatory response syndrome (SIRS), multiple organ dysfunction (MOD), and multiple organ failure (MOF) that may result. This chapter provides an overview for the hematologist-oncologist in managing patients who may present after an R/N incident.
Original language | English |
---|---|
Title of host publication | Oncologic Emergency Medicine |
Subtitle of host publication | Principles and Practice: Second Edition |
Publisher | Springer International Publishing |
Pages | 543-553 |
Number of pages | 11 |
ISBN (Electronic) | 9783030671235 |
ISBN (Print) | 9783030671228 |
DOIs | |
State | Published - Apr 22 2021 |
Externally published | Yes |
Keywords
- Acute radiation syndrome
- Biodosimetry
- Colony-stimulating factors
- Cytokines
- Granulocytopenia
- Hematopoietic
- Improvised nuclear device
- Lymphocyte depletion
- Nuclear
- Nuclear power plant
- Nuclear weapon detonation
- Radiation
- Radiation dispersal device
- Radiation exposure device
- Radioactivity
- Radiological
- Stem cell transplantation
- Terrorism