NOT Bored Review 7/1/14 - Disaster!!!

A young ambitious scientist doing research in gamma radiation to get into his desired radiation oncology residency accidentally pressed the “go” button while in his lab. He presents to the emergency department immediately following the exposure to high-dose total-body radiation. While in the ED he begins having nausea and vomiting, mild confusion and looks ill.

What are the 3 phases of acute radiation syndrome?

Prodrome phase, Latent phase, Manifest illness phase

Please describe the first.

Prodrome: GI symptoms- nausea, vomiting and diarrhea. At extremely high doses, this can be bloody diarrhea

Please describe the second.

Latent phase: this phase is symptom free, awaiting the onset of bone marrow suppression.

Please describe the third.

Manifest illness phase: can take the form of 1 of 3 syndromes.

-Hematopoietic illness: bone marrow suppression with associated complications. Survivable with supportive care.

-GI Illness: reappearance of prodromal phase, survivable with aggressive supportive care.

-Cardiovascular/neurologic illness: AMS and hypotension shortly following exposure. Uniformly fatal in 24-72 hours. From extremely high doses of radiation.**The onset of the illness depends on the radiation dose. The higher the dose, the faster the onset of the prodrome, latent phase and manifest illnesses.**

Special note

Though you are worried, at no point in his course does he develop any of the following: turn into an enormously strong, green creature when angry (aka “the hulk”), light his body afire and fly (aka the “human torch”), turn invisible and cast force shields (aka the “invisible woman”), stretch his body in any way imaginable (aka the “Mr. Fantastic”, permanently turn into a self-consciously ugly, but powerful creature with great strength and rock-hard skin (aka the “thing”).

By Dr. Sally Bogoch and Dr. Andrew Grock

Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7th edition