Pediatric Terrorism and Disaster Preparedness: A ... - PHE Home

Skin pathway. Although intact skin is generally a barrier to most radionuclides, skin
absorption can be important. Most skin absorption occurs through wounds or by passive
diffusion. Examples of the latter include tritium-water and radioactive iodine, which can
pass readily through skin. Skin permeability rates depend on relative solubility in both
lipids and water. Infants are particularly at risk because of their thin epithelium and large
surface area to mass ratio. Injuries such as trauma, burns, and chemical exposures also
increase skin permeability. Abrasions and partial thickness burns create large denuded
skin surfaces, which greatly increases absorption. Clinicians must evaluate all wounds for
the presence of radioactivity, and thoroughly clean, debride, or excise all contaminants.
Uptake and deposition. Uptake can occur by simple deposition, diffusion, or metabolic
processes. Many soluble nuclides are metabolic analogs of body chemicals, so the body
incorporates them like normal building blocks. The critical organs for these soluble
nuclides are identical to storage sites for their metabolic analogs (e.g., radium, calcium,
and bone). Once a soluble radionuclide is absorbed, it may distribute to the whole body.
The liver, kidney, adipose tissue, and bone have higher capacities for binding chemicals,
including radionuclides, due to their high protein and lipid content.
Excretion. Insoluble radionuclides pass through the GI tract unchanged. At least some of
the absorbed nuclide is eventually excreted, either in its original state or as metabolites.
The main route of excretion is via urine, particularly for water-soluble compounds. Lipidsoluble
compounds are excreted via the bile into the intestine. There is much individual
variability in elimination.
Diagnosis
Clinicians may need to evaluate patients who are both contaminated and injured.
Furthermore, patients with internal contamination will almost certainly be externally
contaminated at the time of exposure. Initial management and diagnosis should be
performed simultaneously if possible. Any life- or limb-threatening medical or surgical
emergencies should be addressed first. Initial emergency care is the same as for cases
unrelated to radiation injury, because contamination causes no acute medical effects.
Assessment and treatment of internal contamination must wait until the patient is
medically stable and external decontamination has been completed.
Initial evaluation. The initial evaluation begins at the same time as emergency treatment
and consists of the following:
1. Address life-threatening conditions/injuries – the ABCs.
2. Evaluate and control initial contamination.
3. Assess potential for internal deposition and treat as indicated.
4. Patient history is crucial. Patient (or someone else) states what happened.
5. No sign or symptoms.
6. Perform initial survey (RADIAC) and collect nasal swabs (reflect lung
deposition).
History. Patients exposed to radiation are usually asymptomatic at the time of
presentation. However, history is still the biggest component of initial diagnosis of
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