Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide Slide 35 In the absence of a history of exposure to a gamma source (such as the iridium-192 containing radiography sources shown), the picture on the left could be of a wound from a variety of causes (including a traumatic injury, insect bite, or bacterial or fungal infection). This small wound, shown on the left, with significant surrounding redness (erythema) and swelling (edema) eventually became a significant ulceration (shown on the right). Radiation experts can use the eventual amount of tissue injury to calculate an approximate radiation dose (retrospective dosimetry). Alternatively, a known time of exposure to a known source can be used to develop a prediction of the likely extent of injury for prospective wound and surgical planning purposes. December 2008 Version 2.0 Page 398
Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide Slide 36 Treatment for local radiation injury includes providing for the patients comfort with adequate pain control. They should avoid nicotine, which reduces blood flow to the skin. It is critical to prevent or rapidly treat infections that develop. Surgery to debride devitalized/dead tissue will help prevent infection, but the remaining tissue heals slowly and poorly. Hyperbaric oxygen therapy may have a role in improving blood vessel migration into this damaged tissue.The image shows the chronic wound that can follow localized radiation injuries. Erythema and dry desquamation can be treated symptomatically. Lotions or sprays containing hydrocortisone can be used to relieve the symptoms associated with severe erythema accompanied by edema. To treat moist desquamation, daily dressings and bathing of the affected skin in antiseptic solutions is helpful. Antibiotic creams can also be used. For ulceration, moist dressings and daily cleansing is recommended. Systemic antibiotics should be utilized for verified secondary infection. Surgical debridement can be problematic because of the poor vascularization and integrity of the surrounding tissue. Hyperbaric oxygen treatment has been demonstrated to improve new blood vessel growth and stem cell recruitment to ischemic tissue. It should be considered prior to and after surgical interventions. Opioid analgesics may be necessary for prolonged periods as this chronic wound heals.. The image depicts an individual with an estimated >20 Gy exposure from repeated fluoroscopy exposures to X-rays during a complicated series of angiography procedures on one day. Some erythema developed about 1 month later with desquamation the following week. About 4-5 months after exposure, the area began to ulcerate, with the extensive ulceration seen here at 1½ years after exposure. He eventually underwent skin grafting. December 2008 Version 2.0 Page 399
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Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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