Management Modifiers for
Exposure + Contamination Algorithm


Burns and the Radiation Exposure + Contamination Algorithm


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Trauma and the Radiation Exposure + Contamination Algorithm


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Mass Casualty Emergencies and Radiation Exposure + Contamination Algorithm


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Timing of Surgery and the Radiation Exposure + Contamination Algorithm


  • Radiation exposure + trauma requiring emergency surgery
    • Attempt to take surgical emergencies to the operating room
      • Within 36-48 hours after high-dose radiation exposure
      • Before decline of white blood cell and platelet counts
    • Pre-operative administration of white cell cytokines may extend the time window for surgery.
  • External contamination + trauma requiring emergency surgery
    • Formal external decontamination is appropriate.
    • When clinical urgency does not permit formal decontamination
      • Removal of contaminated clothing can eliminate about up to 90% of external contamination.
      • Traditional surgical skin prep will also help eliminate skin contamination.
      • Avoid pre-op shaving, if possible, to help maintain an intact skin barrier against radioactive materials.
  • Activate hospital emergency radiation response plans
    • If contaminated patients are admitted to the hospital
    • To ensure the health and safety of hospital staff and healthcare team
    • To manage/minimize potential contamination of hospital spaces, including operating and radiology suites
  • This algorithm and supporting material provide guidelines, not mandates.
  • See Radiation Effects on Blood Counts for details.

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Blood Products Use and the Radiation Exposure + Contamination Algorithm


  • Patients with significant whole body radiation exposure (Acute Radiation Syndrome [ARS]) will be immunosuppressed.
    • They are at risk for post-transfusion graft versus host disease (GVHD).
  • Guidelines suggest that these patients should received blood products that have been both
    • Irradiated and
    • Leuko-reduced
  • If irradiated, leuko-reduced blood is unavailable,
    • Emergency transfusions may still be considered.
    • Attention should be paid to possible post-transfusion GVHD.
  • Patients with certain kinds of internal contamination (e.g., Polonium-210)
    • Can also be at risk for ARS
    • Should be evaluated for ARS before receiving blood products
  • Most patients with external contamination but no known radiation exposure
    • Are unlikely to develop ARS
    • Should be evaluated for ARS before receiving blood products
  • This algorithm and supporting material provide guidelines, not mandates.
  • See Blood Products page for details

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At-Risk / Special Needs Populations and the Radiation Exposure + Contamination Algorithm


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