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

• Necrotic areas should be carefully debrided.
• Treatment of radiation fibrosis with pentoxifylline (to improve blood flow) and
vitamin E should be considered.
• There is no standard treatment for radiation fibrosis. Consensus has been to
attempt to treat patients who have a subacute onset of radiation injury with
corticosteroids if they have symptoms. Other agents include pentoxifylline,
vitamin E, colchicines, penicillamine, interferon-gamma, and pirfenidone.
Trauma and Radiation (Timing of Surgery)
The overall morbidity and mortality of trauma patients is exacerbated when there has
been acute exposure to ionizing radiation or contamination with radioactive materials.
Trauma can be in the form of lacerations, puncture wounds, abrasions, gunshot wounds,
blunt force injuries, crush injuries, and burn injuries (see also Chapter 7, Blast
Terrorism).
The initial step in the management of victims with combined injuries, i.e., radiation and
trauma, should be the immediate stabilization of the most life-threatening injury as well
as addressing airway, breathing, and circulation problems. After stabilization, radiation
injury can be assessed and further managed. The fundamental concept to appreciate is
that radiation injuries are not acutely life threatening.
Thermal burn injuries may be complicated by the fact that the wounds may become
contaminated with radioactive particles that need to be removed. Tissue that is irradiated
may not respond in the normal physiological manner afterward. This may affect surgical
success. Animal studies have indicated that performing initial surgery within 36–48 hours
is optimal. Surgery beyond that time puts the patient at risk of life-threatening sepsis due
to profound neutropenia with the acute radiation syndrome.
Management of the Patient with Embedded Radioactive Material
and Depleted Uranium
Radioactive material embedded in wounds should be removed if possible. Otherwise, a
victim is at risk of both infection and local radiation injury. Surgeons should never touch
the radioactive particles (even with a gloved hand) due to the high probability of direct
permanent damage to the fingers. Particles should be touched only with forceps.
Depleted uranium (DU) munitions may be encountered because they are a critical
component of U.S. weaponry. DU has