Radiation exposureMANAGEMENT

SYSTEMIC AND MISCELLANEOUS PRESENTATIONS · 12 SECTIONS

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658 items

☷ Legend

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Cardiovascular Presentations66▾

Respiratory Presentations47▾

Neurological Presentations77▾

Gastrointestinal Presentations63▾

Genitourinary and Reproductive Presentations44▾

Infectious Disease Presentations146▾

Trauma Presentations88▾

Toxicologic Presentations67▾

Psychiatric Presentations25▾

Musculoskeletal and Rheumatologic Presentations89▾

Dermatology Presentations21▾

Environmental and Exposure Presentations26▾

Hematologic and Oncologic Presentations30▾

Pediatric-Specific Presentations13▾

Endocrine and Metabolic Presentations42▾

ENT and Maxillofacial Presentations21▾

Ophthalmologic Presentations15▾

Obstetric Presentations17▾

Systemic and Miscellaneous Presentations15▾

Allergic Transfusion Reaction Anaphylaxis Angioedema Benedikt's Syndrome Cannabis-induced hyperemesis Eczema (acute flare)Gradenigo's Syndrome Horner's Syndrome (Acute)Huntington's Disease (Acute Presentation)Kanavel's Signs Lemierre's Syndrome Radiation exposure Retained products of conception Sever's Disease Urticaria

01Approach to the Critical Patient/attcp96

Initial priorities and scene safety

›Immediate priorities

›Airway compromise triggers

›Stridor

›Facial burns

›Oropharyngeal edema

›Altered mental status

›Breathing failure triggers

›SpO2 < 90% on supplemental oxygen

›Rising PaCO2 in mmHg

›Circulatory instability triggers

›SBP < 90 mmHg

›Signs of shock

›Concurrent trauma and burns as primary determinants of early mortality

›Trauma life support sequence before decontamination

›Hemorrhage control before radiologic survey

›Staff protection

›Time distance shielding principles

›Minimize time near source

›Maximize distance

›Use shielding when feasible

›PPE baseline

›Double gloves

›Fluid resistant gown

›Eye protection

›Surgical mask or respirator based on airborne risk

›Dosimetry and exposure limits per institutional plan

›Personal dosimeter assignment if available

›Rotation of staff during prolonged care

›Patient flow control

›Designated hot warm cold zones

›Hot zone for contaminated clothing and initial survey

›Warm zone for decontamination

›Cold zone for definitive care

›Isolation of belongings

›Bag and label clothing

›Secure personal items for radiation safety

Contamination and decontamination in ED

›Contamination triage

›External contamination versus exposure distinction

›Contamination as removable radioactive material

›Exposure as radiation dose without residual material

›Immediate decontamination triggers

›Visible particulate on skin or hair

›Positive survey over skin or wounds

›Decontamination not delaying life saving interventions

›Airway and hemorrhage control first

›Rapid gross decon during resuscitation only if feasible

›Decontamination steps

›Clothing removal

›Removal of all clothing reduces contamination burden substantially

›Bagging and labeling for radiation safety chain

›Skin and hair

›Lukewarm water and mild soap

›Gentle technique to avoid skin abrasion

›Repeat survey guided decon

›Wounds

›Irrigation with saline

›Removal of foreign material

›Dressing after survey confirmed reduction

›Eye and mouth

›Copious irrigation if particulate exposure

›Avoid ingestion of rinse water

›Radiologic survey and contamination documentation

›Survey meter or portal monitor use if available

›Baseline background reading documentation

›Head to toe survey pattern

›Contaminated wound as highest priority source control

›Wound survey before closure

›Repeat survey after irrigation

Early risk stratification for acute radiation syndrome

›Rapid severity indicators

›Time to emesis after event

›Early vomiting associated with higher whole body dose

›No vomiting by 8 to 10 hours suggests dose likely < 1 Gy

›Absolute lymphocyte count trajectory

›Serial ALC decline over first 48 hours for severity estimate

›Early severe lymphopenia suggesting higher dose

›Cutaneous findings

›Early erythema

›Epilation timing

›Moist desquamation

›Neurovascular signs

›Early confusion

›Ataxia

›Refractory hypotension

›Consultation and escalation triggers

›Radiation safety officer notification

›Any confirmed contamination

›Unknown source event with multiple patients

›Regional poison center or radiation medical support

›Suspected internal contamination

›Need for decorporation agents

›Burn center or trauma center activation

›Combined injury with burns

›Major trauma

›Hematology and transplant network early contact

›Suspected hematopoietic ARS >= 2 Gy

›Anticipated marrow failure

02History/hx62

Exposure characterization

›Event details

›Radiation type and source

›Medical source

›Industrial source

›Nuclear reactor incident

›Radiological dispersal device

›Time course

›Time of event

›Duration of exposure

›Time since exposure

›Distance and shielding

›Proximity to source

›Barriers and sheltering

›Multiple victims and clustering

›Similar symptoms among others

›Shared location exposure

›Contamination risk

›Dust smoke or aerosol exposure

›Inhalation risk

›Eye and mucosal exposure risk

›Ingestion risk

›Food and water sources

›Hand to mouth exposure

›Wounds in contaminated environment

›Open injuries at event

›Embedded particulate

Symptom timeline and classic phases

›Prodromal symptoms

›Nausea

›Vomiting onset time

›Diarrhea

›Fatigue

›Headache

›Latent phase indicators

›Symptom improvement after prodrome

›Return of appetite

›Manifest illness domain symptoms

›Hematopoietic

›Fever

›Sore throat

›Bleeding

›Gastrointestinal

›Persistent diarrhea

›Abdominal pain

›Dehydration

›Cutaneous

›Erythema timing

›Blistering

›Pain out of proportion

›Neurovascular

›Confusion

›Ataxia

›Seizure

Risk factors and modifiers

›Patient factors

›Age extremes

›Pregnancy status

›Immunosuppression

›Baseline marrow disease

›Combined injury

›Thermal burns

›Blast trauma

›Chemical exposure

›Smoke inhalation

03Physical Exam/exam44

Primary survey focused findings

›Airway and breathing

›Facial burns and soot

›Hoarseness

›Oropharyngeal edema

›Respiratory distress

›Tachypnea

›Hypoxia

›Circulation

›Shock markers

›Cool clammy skin

›Delayed capillary refill

›Hemorrhage indicators

›External bleeding

›Petechiae or ecchymoses

›Neurologic status

›GCS trend

›Rapid decline suggesting high dose or alternate cause

›Focal deficits suggesting trauma or stroke

Radiation specific examination

›Cutaneous radiation injury

›Early erythema

›Sharply demarcated fields

›Burning pain or pruritus

›Epilation

›Patchy hair loss distribution

›Timing after event

›Blistering and ulceration

›Moist desquamation

›Necrosis signs

›Infection and bleeding

›Oropharyngeal ulcers

›Mucositis

›Thrush

›Skin and line infection signs

›Cellulitis

›Purulence

›Bleeding stigmata

›Gingival bleeding

›Melena or hematochezia

PITFALLS

›Misattribution risks

›Vomiting from anxiety pain or head injury

›Diarrhea from infection or toxins

›Under recognition risks

›Latent phase appearing well despite high dose

›Localized radiation injury with minimal systemic symptoms

04Differential Diagnosis/ddx39

Life threatening mimics and co exposures

›Toxidromes and chemical exposures

›Organophosphate poisoning ICD-10 T60

›SLUDGE features

›Bradycardia

›Cyanide toxicity ICD-10 T65.0

›Severe lactic acidosis

›Soot exposure

›Carbon monoxide poisoning ICD-10 T58

›Headache

›Altered mental status

›Sepsis and gastroenteritis

›Sepsis ICD-10 A41

›Fever and hypotension

›Elevated lactate

›Viral gastroenteritis ICD-10 A08

›Vomiting and diarrhea cluster

›Trauma and burns

›Traumatic brain injury ICD-10 S06

›Vomiting and confusion

›Thermal burn ICD-10 T20 to T32

›Hypovolemia

›Pain

Radiation related syndromes and patterns

›Acute radiation syndrome SNOMED CT concept

›Hematopoietic syndrome

›Neutropenia

›Thrombocytopenia

›Gastrointestinal syndrome

›Severe diarrhea

›Electrolyte derangements

›Neurovascular syndrome

›Early neurologic collapse

›Cardiovascular failure

›Localized radiation injury

›Cutaneous radiation injury

›Delayed ulceration

›Progressive fibrosis

›Radiation cataract

›Eye pain and photophobia

›Delayed lens changes

05Laboratory Tests/lt50

Core labs for ARS and combined injury

›Baseline evaluation

›CBC with differential

›Absolute lymphocyte count for early biodosimetry

›Neutrophil nadir prediction with serial trends

›CMP with electrolytes

›Diarrhea related hypokalemia

›Renal function for chelator dosing

›Lactate in mmol/L

›Shock marker

›Sepsis screening

›Coagulation studies

›Bleeding risk evaluation

›DIC in severe combined injury

›Serial trend strategy

›CBC frequency

›Every 4 to 6 hours for first 24 hours when dose uncertain

›Daily or more frequent based on trajectory

›ALC kinetics

›Declining ALC over 48 hours supporting higher dose estimation

›Stabilizing ALC supporting lower dose

Infection and supportive care labs

›Neutropenic fever workup

›Blood cultures

›Peripheral and line if present

›Before antibiotics when feasible

›Urinalysis and culture

›Urinary symptoms

›Indwelling catheter

›Chest imaging correlation

›Respiratory symptoms

›Hypoxia

›Bleeding and transfusion planning

›Type and screen

›Anticipated platelet transfusions

›Anticipated RBC transfusions

›Fibrinogen

›Consumptive coagulopathy screening

Specialized radiologic injury testing

›Biodosimetry support tests

›Cytogenetic dicentric chromosome assay

›Dose estimation reference standard where available

›Utility window days to weeks

›Chromosome translocation assays

›Longer term dose reconstruction

›Not for acute triage

›Internal contamination assessment

›Nasal swabs

›Screening for inhaled radioactive particulate

›Not quantitative dose measure

›Urine and fecal bioassay

›Specific radionuclide identification

›Serial collection for kinetics

06Diagnostic Tests/dt56

Scoring Systems

›Triage based on clinical and lab surrogates

›Time to emesis based categories

›Earlier onset associated with higher dose

›No emesis by 8 to 10 hours suggests dose likely < 1 Gy

›Lymphocyte depletion kinetics

›Serial ALC trend within first 48 hours as severity estimator

›Marked early decline supporting higher dose

›METREPOL style organ involvement grading

›Hematopoietic grade by cytopenias

›GI grade by diarrhea and dehydration

›Combined injury prognostication

›Burn plus radiation dose synergy

›Higher infection risk at any neutropenia

›Worse survival at similar dose with burns

MRI

›MRI role

›Limited utility for ARS diagnosis

›ARS clinical and laboratory diagnosis

›MRI reserved for complications

›Neurologic evaluation when trauma excluded

›Brain MRI for persistent deficits

›Spinal MRI for myelopathy

›MRI constraints

›Unstable patient limitation

›Monitoring constraints in scanner

›Need for airway control

›Contamination control

›Decontamination before MRI suite

›Radiation safety clearance

›CT indications

›Trauma evaluation

›Head CT for altered mental status with trauma concern

›CT chest abdomen pelvis for suspected internal injury

›Complication evaluation

›CT abdomen pelvis for severe abdominal pain and ileus

›CT chest for suspected pneumonia in neutropenia

›CT operational considerations

›Contamination management

›Gross decon before transport

›Coverings to limit scanner contamination

›Radiation from CT not a clinical driver in mass casualty exposure context

›Diagnostic yield prioritized when indicated

›Avoid delay of necessary imaging

Ultrasound

›POCUS applications

›Shock and trauma

›FAST or eFAST for free fluid or pneumothorax

›Cardiac POCUS for tamponade

›Vascular access

›Ultrasound guided peripheral or central access

›Line placement in PPE constraints

›POCUS infection support

›Lung ultrasound

›Consolidation patterns

›Pleural effusion

›Soft tissue ultrasound

›Abscess detection

›Cellulitis differentiation

07Disposition/dispo46

Level of care decisions

›Immediate admission criteria

›Suspected whole body dose >= 2 Gy

›Significant early vomiting

›Rapid ALC decline

›Any neutropenic fever

›Temp >= 38.3 C once

›Temp >= 38.0 C sustained 1 hour

›Combined injury

›Major burns

›Major trauma

›ICU criteria

›Hemodynamic instability

›Vasopressor requirement

›Rising lactate in mmol/L

›Severe GI syndrome

›Refractory dehydration

›Electrolyte collapse

›Neurovascular syndrome features

›Early severe confusion

›Seizure

›Transfer criteria

›Need for burn center

›Partial thickness burns > 10% TBSA

›Airway burns

›Need for marrow failure management center

›Anticipated prolonged neutropenia

›Need for CSF supply coordination

›Need for radiation specialty support

›Internal contamination requiring decorporation

›Complex wound contamination

Discharge criteria

›Low risk features

›No significant symptoms after observation window

›No vomiting

›No diarrhea

›Normal exam

›No burns or trauma requiring admission

›No concerning skin findings

›Low risk lab features

›CBC reassuring

›No lymphopenia trend on repeat testing when obtained

›No cytopenias

›Follow up plan established

›Return precautions

›Fever

›Bleeding

›Outpatient repeat CBC timing

08Treatment/t127

Supportive care and symptom control

›Antiemetics

›Ondansetron

›4 mg IV

›Repeat every 8 hours as needed

›Metoclopramide

›10 mg IV

›Avoid in prolonged QT or extrapyramidal risk

›Fluids and electrolytes

›Isotonic crystalloid

›Bolus 10 to 20 mL/kg for shock

›Maintenance guided by urine output

›Diarrhea replacement

›Potassium repletion per institutional protocol

›Magnesium repletion as needed

›Pain control

›Opioid analgesia when indicated

›Titration to effect with respiratory monitoring

›Avoid hypotension in shock

Hematopoietic syndrome management

›Colony stimulating factors for suspected hematopoietic ARS

›Filgrastim

›5 mcg/kg/day SC

›Start within 24 to 48 hours when feasible

›Continue until ANC recovery per specialist guidance

›Pegfilgrastim

›6 mg SC once

›Alternative when daily dosing not feasible

›Sargramostim

›250 mcg/m2/day SC or IV

›Specialist guided use

›Infection prophylaxis and treatment

›Febrile neutropenia antibiotics

›Cefepime

›2 g IV every 8 hours

›Renal adjustment per eGFR

›Piperacillin tazobactam

›4.5 g IV every 6 hours

›Renal adjustment per eGFR

›Meropenem

›1 g IV every 8 hours

›Reserve for resistant risk

›Antiviral prophylaxis in prolonged neutropenia

›Acyclovir

›400 mg PO twice daily

›Renal adjustment per eGFR

›Antifungal prophylaxis when prolonged profound neutropenia anticipated

›Fluconazole

›400 mg PO daily

›Consider mould active agent per local risk

›Transfusion support

›Platelets

›Threshold < 10 x10^9/L for prophylaxis

›Threshold < 20 x10^9/L with fever or bleeding risk

›Higher threshold for procedures per consultant

›RBC transfusion

›Symptomatic anemia

›Hemodynamic compromise

›Stem cell transplant considerations

›Not first line for most mass casualty settings

›Candidate selection by specialist team

›Persistent marrow aplasia with supportive failure

›Exclusion of unsurvivable GI or neurovascular syndrome

Gastrointestinal and neurovascular syndrome management

›GI syndrome support

›Aggressive volume support

›IV fluids guided by hemodynamics

›Electrolyte correction

›Antidiarrheals when infection excluded

›Loperamide

›4 mg PO once

›2 mg PO after each stool

›Max 16 mg/day

›Nutrition support

›Early enteral nutrition if tolerated

›Parenteral nutrition in prolonged ileus

›Neurovascular syndrome support

›Critical care management

›Airway protection

›Vasopressors for shock

›Goals of care discussions when syndrome suggests unsurvivable exposure

›Specialist input for prognosis

›Palliative care involvement

Internal contamination and decorporation

›Potassium iodide for radioiodine exposure prophylaxis

›Adult dose

›130 mg PO daily

›Start as soon as possible

›Pediatric dosing

›12 to 18 years

›65 mg PO daily

›3 to 12 years

›65 mg PO daily

›1 month to 3 years

›32 mg PO daily

›Birth to 1 month

›16 mg PO daily

›Contraindications and cautions

›Iodine hypersensitivity history

›Dermatitis herpetiformis

›Thyroid disease monitoring in neonates

›Prussian blue for cesium or thallium

›Adult dose

›3 g PO three times daily

›Continue based on bioassay guidance

›Pediatric dose

›1 g PO three times daily for 2 to 12 years

›Weight based specialist adjustment

›Adverse effects

›Constipation

›Blue stools

›DTPA for plutonium americium curium

›Ca DTPA initial

›1 g IV once as soon as possible

›Prefer within first 24 hours

›Zn DTPA subsequent

›1 g IV daily or per specialist plan

›Preferred for ongoing therapy

›Monitoring

›Electrolytes and trace metals

›Renal function

Cutaneous radiation injury and contaminated wounds

›Local radiation injury care

›Early dermatology and burn consultation

›Pain out of proportion

›Progressive erythema and blistering

›Wound management

›Irrigation and debridement as indicated

›Delay closure until contamination reduced when feasible

›Infection prevention

›Standard burn wound protocols

›Early antibiotics only when infection suspected

09Special Populations/sp45

Pregnancy

›Maternal fetal considerations

›Gestational age documentation

›First trimester highest teratogenic risk

›Later pregnancy growth and neurodevelopment risk

›Maternal stabilization as priority

›Resuscitation targets same as nonpregnant

›Left uterine displacement in late pregnancy shock

›Radiation counseling needs

›Dose estimate coordination with radiation experts

›Obstetrics and maternal fetal medicine involvement

›Medication considerations

›Potassium iodide use when indicated

›Benefit in radioiodine exposure

›Thyroid monitoring in neonate after delivery

›DTPA and Prussian blue specialist guided risk benefit

›Use when maternal benefit outweighs fetal risk

›Lactation counseling when radionuclide present

Geriatric

›Higher vulnerability factors

›Reduced physiologic reserve

›Dehydration risk with GI syndrome

›Delirium risk

›Baseline marrow compromise

›Myelodysplasia prevalence considerations

›Medication induced cytopenias

›Treatment adjustments

›Renal dosing for antimicrobials and chelators

›eGFR based adjustments

›Avoid nephrotoxins when possible

›Delirium minimizing care

›Avoid anticholinergics

›Early mobilization when safe

Pediatrics

›Dose and presentation differences

›Higher risk per body size in similar exposure scenarios

›Higher effective dose from same contamination

›Faster dehydration with diarrhea

›Weight based dosing for supportive meds

›Fluids 10 to 20 mL/kg bolus for shock

›Antiemetics per pediatric protocols

›KI dosing and thyroid follow up

›Neonatal thyroid suppression risk

›TSH and free T4 follow up after KI exposure

›Repeat testing per pediatrics

›Psychosocial support needs

›Family centered care

›Separation minimization during decon

10Background/b41

Epidemiology

›Exposure contexts

›Industrial and medical source accidents

›Radiography sources

›Radiotherapy misadministration

›Nuclear power incidents

›Reactor release with contamination

›Evacuation and sheltering public health measures

›Deliberate radiological events

›Radiological dispersal device

›Improvised nuclear device

›ARS rarity and risk thresholds

›ARS typically requires large acute whole body dose > 0.7 Gy

›Mild symptoms possible at doses around 0.3 Gy

Pathophysiology

›Mechanisms

›Ionizing radiation DNA damage

›Double strand breaks

›Mitotic cell death

›High turnover tissue sensitivity

›Bone marrow stem cells

›GI crypt cells

›Skin basal cells

›Syndrome domains by dose and target organ

›Hematopoietic syndrome

›Marrow aplasia

›Infection and bleeding

›Gastrointestinal syndrome

›Mucosal denudation

›Bacterial translocation

›Neurovascular syndrome

›Capillary leak

›Cardiovascular collapse

Therapeutic Considerations

›Key management principles

›Trauma and burn care dominates early survival in combined injury

›Decontamination reduces ongoing exposure and spread

›Severity estimation guides resource allocation

›Growth factor rationale

›Shortens duration of neutropenia

›Improves hematopoietic recovery in moderate to severe exposure

›Decorporation rationale

›Reduces internal dose by interrupting absorption or enhancing excretion

›Highest benefit when started early for specific radionuclides

11Patient Discharge Instructions/pdi30

Copy discharge instructions

›Home care and monitoring

›Shower with soap and water if advised

›Avoid skin abrasion

›Bag and launder clothing separately if instructed

›Hydration targets

›Oral fluids to maintain pale urine

›Oral rehydration solution if diarrhea

›Return to ED now

›Fever

›Temp >= 38.0 C

›Chills or rigors

›Bleeding

›New bruising

›Nosebleeds or gum bleeding

›Persistent vomiting

›Unable to keep fluids down

›Signs of dehydration

›Severe diarrhea

›Blood in stool

›Lightheadedness or fainting

›Worsening skin injury

›Increasing redness or blistering

›Increasing pain

›Follow up

›Repeat CBC timing per clinician plan

›Within 24 to 72 hours when exposure uncertain

›Earlier if symptoms develop

›Public health or radiation clinic follow up when arranged

›Internal contamination evaluation

›KI follow up thyroid testing in infants and children

12References/r22

Clinical guidance and decision support sources

›Core emergency guidance

›CDC Acute Radiation Syndrome clinical guidance for clinicians

›ARS dose threshold > 0.7 Gy

›Mild symptoms possible at 0.3 Gy

›REAC TS hospital medical management guidance

›ED decontamination and contamination control

›Hospital operational planning for radiological incidents

›HHS REMM clinical tools

›Time dose effects tables for ARS

›Triage and treatment resources

›IAEA EPR Medical 2024 guidance

›Medical triage and radiological survey principles

›Contaminated wound management in emergencies

›Health Canada guide on medical management of radiological exposures

›Screening assessment and emergency department treatment framework

›Hematopoietic support guidance

›NCCN Hematopoietic Growth Factors guidance

›Growth factor use in radiation induced myelosuppression

›Neutropenic fever management framework

›AFRRI Medical Management of Radiological Casualties handbook

›Vomiting timing for dose estimation

›Early CSF use for moderate to severe exposure

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.