Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide Slide 31 There are several algorithms that can be used to guide management and treatment decisions based on likely radiation dose received. One example is shown here where time to onset of vomiting is correlated with radiation dose. However, note that not all people will vomit, particularly at lower doses. In these situations it is helpful to have additional measurements, such as the lymphocyte depletion rate shown on the next slide. The need for early specialized care is to optimize chances for survival, which will entail strict attention to fluid and electrolyte balance, early operative care if indicated, preparation for neutropenia and use of reverse isolation procedures and specialized medications to increase bone marrow response (cytokines). The National Library of Medicine site has an interactive algorithm that is very useful. December 2008 Version 2.0 Page 394
Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide Slide 32 The Andrews nomogram depicts early lymphocyte depletion following radiation exposure and can also be used to estimate dose (exposure to radiation). The lymphocyte count is derived from the complete blood count mentioned in a prior slide. The left axis is the lymphocyte count, and the bottom axis is the time since exposure. The green lines represent dose estimates which relates on the right to prognosis. The more rapid the lymphocyte fall (depletion), the higher the likely radiation dose; and the more severe the ensuing clinical course. A fall of the lymphocyte count below 1000 cells/milliliter of blood within 24 hours after exposure suggests a dose over 6 Gy and a very severe course, while a drop below 1000 cells/ml within 12 hours may indicate a lethal exposure of over 8 Gy range. . December 2008 Version 2.0 Page 395
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Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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