Getting Started

Potential Incidents
Planning
Decontamination
Triage
Treatment
Pharmacotherapy

Scenario 1
Scenario 2
Scenario 3
Scenario 4
Scenario 5
Scenario 6

Glossary
Resources
Self Test

Getting Started

Potential Incidents
Planning
Decontamination
Triage
Treatment
Pharmacotherapy

Scenario 1
Scenario 2
Scenario 3
Scenario 4
Scenario 5
Scenario 6

Glossary

Resources

Self Test

Radiological and Nuclear Terrorism:
Medical Response to Mass Casualties

Scenario 4

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Given this exposure history and clinical presentation, what special precautions should be taken by the staff?

Incorrect! This patient was exposed to a radioactive source but was not contaminated. No special precautions are needed. Radioprotective PPE was utilized until the hospital staff confirmed the absence of contamination.

Correct! This patient was exposed to a radioactive source but was not contaminated. No special precautions are needed. Radioprotective PPE was utilized until the hospital staff confirmed the absence of contamination.

Standard precautions PPE with N-95.

Handling excretions in accordance with radioactive hazard protocols.

Double-bagging and labeling clothing as radioactive.

If the patient expires, the body should be decontaminated.

None of the above.

In this scenario, which of the following will be most helpful in assessing radiation dose in the Emergency Department (ED)?

Incorrect! Monitoring for progressive declines in absolute lymphocyte count will provide the most definitive estimate of radiation dose. The time to first emesis post exposure provides a rough dose estimate. The gold standard for dose estimation is a count of the number of dicentric chromosomes in peripheral blood lymphocytes. Processing, which requires 48 - 72 hours, is done in a specially equipped laboratory utilizing federal assistance. Excreta analysis, which also requires 48 - 72 hours for processing, assists in assessing for internal contamination. Whole body counters, which are not readily accessible, and gamma cameras, available in nuclear medicine or radiology departments, may also be used to assess for internal contamination. However, this patient was not contaminated.

Correct! Monitoring for progressive declines in absolute lymphocyte count will provide the most definitive estimate of radiation dose. The time to first emesis post exposure provides a rough dose estimate. The gold standard for dose estimation is a count of the number of dicentric chromosomes in peripheral blood lymphocytes. Processing, which requires 48 - 72 hours, is done in a specially equipped laboratory utilizing federal assistance. Excreta analysis, which also requires 48 - 72 hours for processing, assists in assessing for internal contamination. Whole body counters, which are not readily accessible, and gamma cameras, available in nuclear medicine or radiology departments, may also be used to assess for internal contamination. However, this patient was not contaminated.

Presence of nausea and vomiting.

Lymphocyte depletion kinetics.

Chromosomal aberration biodosimetry.

Bioassay samples of urine, stool.

Gamma cameras or whole body counters.

Drawn three hours post ED admission, the results of this patient’s CBC and differential indicate normal counts for all values. Which of the following conclusions can be drawn from these results?

Incorrect! Although lymphocytes are the most radiosensitive cells within the body, the absolute lymphocyte count will not typically show significant declines until 12 hours post exposure. In this scenario, radiological triage indicates prolonged exposure that will likely result in the development of ARS.

Correct! Although lymphocytes are the most radiosensitive cells within the body, the absolute lymphocyte count will not typically show significant declines until 12 hours post exposure. In this scenario, radiological triage indicates prolonged exposure that will likely result in the development of ARS.

A low dose of radiation was received.

Nausea did not result from radiation exposure.

The patient may be discharged with outpatient follow-up.

This patient does not have systemic radiation injury.

None of the above.

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