Acute radiation injuries

Emergency conditions in acute radiation injuries as a result of exposure to the human body of penetrating ionizing radiation that occur both in the period of the primary reaction to radiation and in the period of the height of the disease include: repeated, therapy-resistant vomiting, severe dehydration, convulsive syndrome, acute cardiovascular vascular insufficiency and heart rhythm disturbances, symptoms of increasing cerebral edema, deep disorders of consciousness, severe abdominal pain syndrome. In addition, emergency medical care may require massive incorporation of radionuclides and massive contamination of body surfaces and uniforms with radionuclides.

In the initial period after irradiation, in severe forms of damage, the following dominate: severe nausea, vomiting, intense headache, depression of consciousness, abdominal cramps, diarrhea, muscle weakness up to weakness, fever, hemodynamic disorders (cardiovascular insufficiency, heart rhythm disturbances), diffuse skin hyperemia, anorexia. During the height of the disease, cytopenic infections and hemorrhagic syndrome develop.

First aid. It consists in protecting the body from the adverse effects of ionizing radiation: exit (removal) from the danger zone, decontamination of uniforms), taking a standard radioprotector from an individual first-aid kit – 3 tablets (450 mg) of the B-190 preparation inside, thoroughly chewing, in 10-15 minutes before the start of the expected exposure (before entering the potentially dangerous zone of radioactive contamination), ingestion of a standard means of preventing the primary reaction to radiation – 1-2 tablets (4-8 mg) of ondansetron.

First aid. With developed vomiting – intramuscular injection of 2-4 ml of a 0.2% solution of ondansetron.

With signs of dehydration against the background of treatment-resistant vomiting – intravenously 500-1000 ml of 0.9% sodium chloride solution;

With the development of seizures – intramuscularly 2-4 ml of a 0.5% solution of diazepam;

With severe disorders of consciousness – in order to prevent asphyxia, the installation of an air duct ;

With psychomotor agitation and fear reactions – intramuscularly 2 ml of a 0.5% solution of diazepam;

If there is a threat of incorporation of radioisotopes of iodine in the thyroid gland – inside 1 tablet (125 mg) of potassium iodide, and if massive incorporation of radioactive cesium is indicated – ferrocin 2 tablets (1000 mg) inside;

With diarrhea – inside loperamide 2 capsules (4 mg) once;

With skin itching with local radiation damage – inside 1 tablet of diphenhydramine (50 mg);

With severe pain syndrome – intramuscularly metamizole sodium 50% – 2-4 ml.

If the uniform is contaminated with radioactive dust – its partial decontamination and respiratory protection with personal respiratory protection equipment (gas mask, respirator).

First aid. Emergency first aid measures include:

– in case of contamination of the skin, uniforms and personal protective equipment with radioactive substances above the permissible levels (200 parts / (cm 2 x min)) for beta-active nuclides for intact skin and the inner surface of the front parts of personal protective equipment; 2000 part / (cm 2 x min) – uniforms) – complete sanitization;

– with severe vomiting – repeated intramuscular injection of 2 ml of a 0.2% solution of ondansetron (if ineffective – intramuscularly 2 ml of a 0.5% solution of metoclopramide); with indomitable vomiting – bring the total dose of ondansetron to 8 mg / day (if ineffective – subcutaneous injection of 1 ml of a 0.1% solution of atropine ) ; if not effective – a single intravenous injection of 20 mg of dexamethasone (5 ml of a 0.4% solution);

– in acute cardiovascular failure – injections of phenylephrine (1 ml of a 0.1% solution subcutaneously) or epinephrine (1 ml of a 0.1% solution subcutaneously or intramuscularly)

– with severe disorders of consciousness – in order to prevent asphyxia, the installation of an air duct, oxygen inhalation and respiratory support according to indications;

– with ongoing diarrhea – loperamide inside 2 capsules of 0.002 (not earlier than 6 hours after the previous dose);

– with a clinical picture corresponding to the severe severity of acute radiation syndrome, subcutaneous injection of 1 ml (1 μg) of betaleykin (the lyophilisate is diluted to 1 ml with saline).

– with severe pain syndrome – intramuscular injection of metamizole sodium 50% – 2-4 ml;

– with severe spastic abdominal pain – subcutaneous injection of 1 ml of a 0.1% solution of atropine (if not previously administered);

– with severe dehydration – intravenous administration of 500 ml of 0.9% sodium chloride solution, drinking plenty of water;

– in acute vascular insufficiency – 1 ml of a 5% solution of ephedrine subcutaneously, intramuscularly or intravenously slowly;

– with the development of seizures – intramuscularly 2-4 ml of a 0.5% solution of diazepam;

– in case of psychomotor agitation, inadequacy of behavior within the framework of an acute reactive state, a weapon is withdrawn from the victim, he is fixed to a stretcher, after which 2 ml of a 0.5% solution of diazepam is injected intramuscularly;

– with severe skin itching – intramuscular injection of 1 ml of 1% diphenhydramine.

– administration of 1 tablet (125 mg) of potassium iodide orally to prevent the accumulation of radioactive iodine in the thyroid gland (if not used before, 1 tablet is used per day for 7-10 days);

– oral administration of 2 tablets (1000 mg) of ferrocin in case of incorporation of radioactive cesium (if it has not been used before and not earlier than 8 hours after the previous dose).

Evacuation to a military hospital or the nearest specialized medical institution, on a stretcher by ambulance, accompanied by a doctor (paramedic), continuing emergency care.

Anaphylactic shock

Anaphylactic shock is an acute systemic allergic reaction to repeated contact with an allergen, life-threatening and accompanied by severe hemodynamic disturbances, as well as dysfunction of other organs and systems.

The first symptom (harbinger) of the development of anaphylactic shock is a pronounced local reaction at the site of entry of the allergen into the body – unusually severe pain, severe swelling, swelling and redness at the site of an insect bite or drug injection, severe itching of the skin, quickly spreading throughout the skin (generalized itching). When the allergen is taken orally, the first symptom may be a sharp pain in the abdomen, nausea and vomiting, diarrhea, swelling of the oral cavity and larynx. With the introduction of the drug intramuscularly, the appearance of retrosternal pain (strong compression under the ribs) is observed from 10-60 minutes after the injection of the drug. Expressed edema of the larynx, bronchospasm and laryngospasm quickly join, leading to a sharp difficulty in breathing. Difficulty breathing leads to the development of rapid, noisy, hoarse (“asthmatic”) breathing. Hypoxia develops: the lips and visible mucous membranes, as well as the distal ends of the limbs (fingers) may become cyanotic (bluish). The patient may lose consciousness or faint. In a patient with anaphylactic shock, blood pressure drops sharply and collapse develops, which is manifested by pallor (grayness) of the skin, a thready pulse, and severe hypotension. With severe disorders of central hemodynamics, clonic convulsions occur. With a lightning-fast form, a terminal state may occur in 2-5 minutes.

First aid. Stop the allergen from entering the body. If the cause of the reaction is the administration of the drug or an insect bite, a tourniquet is applied above the site of the allergen (for 25-30 minutes). Every 10 minutes, the tourniquet is loosened for 1-2 minutes. Apply ice or a heating pad with cold water to the injection site for 15 minutes. When instilling an allergenic medication, rinse the nasal passages and conjunctival sacs with running water.

With signs of systemic hypotension (general weakness, pallor of the skin, thready pulse), ensure rest. Horizontal position with raised legs. If the clinical picture is dominated by the phenomena of bronchospasm, then the position of the patient is semi-sitting. In the absence of consciousness, put the patient on the right side, push the lower jaw, remove the prostheses. Ensure fresh air supply.

Call for medical assistance or emergency delivery lying to the medical unit.

First aid. The activities of the previous stage are being carried out. When taking an allergen orally, it is necessary to wash the patient’s stomach. Prick “crosswise” the injection site (“sting”) with a 0.1% solution of epinephrine. For this, 1 ml of epinephrine 0.1% solution is diluted 1:5 with 0.9% sodium chloride solution. Apply ice to the injection site.

Emergency catheterization of a peripheral (cubital) vein in order to provide venous access. If the reaction occurred during intravenous administration of the drug, then you do not need to leave the vein! It is only necessary to disconnect the syringe or system containing the allergen. In severe hypotension, immediate intravenous administration of epinephrine: 1 ml of a 0.1% solution of epinephrine is diluted in 10 ml of physiological saline (in 1 ml of the resulting solution = 0.1 mg of epinephrine). The resulting solution (1:10,000) is administered intravenously very slowly (within 5-10 minutes) with constant monitoring of pulse and blood pressure (systolic blood pressure must be maintained at a level above 100 mm Hg).

If the effect of epinephrine is insufficient, they resort to jet administration of glucocorticoids (prednisolone 60-90 mg), with insufficient effectiveness – to intravenous administration of adrenomimetics (phenylephrine – 0.5-1 ml of a 1% solution). To stabilize blood pressure at the desired level, infusion of plasma expanders (0.9% sodium chloride solution, 5% dextrose solution) can be undertaken at a rate of (0.5-1.0 l in 15-30 minutes).

If catheterization of peripheral veins is not possible due to their collapse, then adrenomimetics (0.1% solution of epinephrine 1 ml, previously diluted in 5 ml of 0.9% sodium chloride) can be injected into the muscles of the floor of the mouth – under the tongue, followed by catheterization of the peripheral veins and providing venous access with subsequent administration of drugs (phenylephrine – 0.5-1 ml of a 1% solution and prednisone 60-90 mg) intravenously. In the absence of the expected effect (restoration of blood supply to peripheral veins sufficient to provide vascular access within 5-10 minutes), repeated administration of adrenaline (see above) into the muscles of the floor of the mouth up to 3 times within an hour is indicated.

Diphenhydramine 25-50 mg intravenously (over 5-10 minutes), intramuscularly or orally. A single dose of the drug should not exceed 100 mg. The route of administration depends on the severity of the anaphylactic reaction. Diphenylhydramine does not replace the administration of epinephrine. Then the drug is prescribed at a dose of 25-50 mg orally every 6 hours for 2 days. This helps prevent the resumption of symptoms of an anaphylactic reaction (especially often observed with urticaria and angioedema).

With the clinical picture of an attack of bronchial asthma, appropriate treatment (see the Instructions section “Attack of bronchial asthma”). Oxygen inhalation is indicated.

In case of failure of urgent treatment measures and progression of violations of vital functions, further assistance is provided according to CPR standards (see “Clinical death (cardiopulmonary resuscitation”).

First aid. The diagnostic measures of the previous stage are repeated, including pulse oximetry, ECG. If necessary, inhalation of oxygen through nasal catheters.

Emergency catheterization of a peripheral (cubital) vein in order to provide venous access. In severe hypotension, immediate intravenous infusion of plasma expanders (0.9% sodium chloride solution, 5% dextrose solution) at a rate of (0.5-1.0 l in 15-30 minutes). If the rapid introduction of plasma expanders does not provide stabilization of blood pressure at the desired level, they resort to intravenous drip administration of adrenomimetics in 400 ml of 5% dextrose solution: 0.5-1 ml of 1% phenylephrine solution, 1 ml of 0.2% norepinephrine solution). To maintain SBP above 90-100 mm Hg. epinephrine may be given slowly intravenously. To do this, 1 ml of a 0.1% solution of epinephrine is diluted in 250 ml of a 0.9% solution of sodium chloride (the concentration of the resulting solution of epinephrine is 4 μg / ml). The initial rate of administration is 1 µg/min. If ineffective in the absence of side effects, it can be increased to 4 mcg / min.

With insufficient effectiveness of adrenomimetics to maintain SBP, they resort to jet intravenous administration of glucocorticoids (prednisolone 60-90-120 mg). Subsequently, prednisolone is administered intramuscularly or intravenously 90-120 mg every 6-8 hours during the first day after the development of anaphylaxis. Dexamethasone 8-32 mg can also be used.

Diphenhydramine 25-50 mg intravenously (over 5-10 minutes), intramuscularly or orally. A single dose of diphenhydramine should not exceed 100 mg. The route of administration depends on the severity of the anaphylactic reaction. Diphenhydramine does not replace the administration of epinephrine. Then the drug is prescribed at a dose of 25-50 mg orally every 6 hours for 2 days. This helps prevent the resumption of symptoms of an anaphylactic reaction (especially often observed with urticaria and angioedema).

Treatment of severe bronchospastic syndrome in accordance with the principles of treatment of an attack of bronchial asthma (see the Instructions section “Attack of bronchial asthma”).

After stabilization of SBP above 90 mm Hg. – control of kidney function. Continuation of infusion therapy with blood-substituting solutions, including, if necessary, intravenous administration of dopamine, norepinephrine, glucocorticoids under the control of blood pressure, hourly diuresis.

In case of failure of urgent measures for the treatment of AS and progression of violations of vital functions, further assistance is provided according to CPR standards (see “Clinical death (cardiopulmonary resuscitation)”).

Evacuation to a military hospital or the nearest specialized medical institution, on a stretcher by ambulance, accompanied by a doctor (paramedic), continuing emergency care.

burn shock

It develops with extensive superficial (more than 20% of the body surface) and deep (more than 10%) burns. When combined with inhalation lesions of the respiratory tract, it can also occur with a smaller burn area.

Complaints of pain in the burn area, thirst and chills, nausea and vomiting are possible. On examination, pale, cold to the touch, unaffected skin is determined. Body temperature is normal or subnormal. Tachycardia, tachypnea. In severe cases, a decrease in blood pressure, the appearance of dark urine with a burning smell.

Signs of inhalation damage: burns of the face, nose, lips, tongue, soft palate, singed hair in the nose, soot deposits in the nasal passages and on the oropharyngeal mucosa, hoarseness, cough, shortness of breath, swelling and redness of the mucous membrane of the mouth and pharynx, asphyxia is possible .

First aid. Stop exposure to the thermal agent and remove the affected person from the fire. Smoldering or burnt clothing must be removed. Fragments of clothing adhering to the burnt surface are not torn off, but carefully cut off. For small burns, a bandage is applied to the affected area using an individual dressing bag. For extensive burns, any dry, clean cloth that does not contain ointments or fats is used. For burns associated with fractures and other mechanical injuries, transport immobilization is necessary. It is necessary to warm the victim (cover warmly), give a warm drink, if possible – many times in small portions.

First aid. Warming continues by all possible means. In the absence of vomiting, thirst is quenched, fluid and electrolyte losses are compensated by drinking an alkaline-salt solution (2 teaspoons of table salt and 1 teaspoon of baking soda per 1 liter of water) in portions of 100 ml every 10-15 minutes. With nausea and vomiting, infusion therapy begins with 0.9% sodium chloride solution – 1000 ml. According to indications, respiratory disorders are eliminated, non-narcotic analgesics are introduced.

Poorly applied dressings should be corrected and supplemented.

Defects of transport immobilization are eliminated.

First aid. Infusion therapy: intravenous infusion of glucose-salt solutions (0.9% sodium chloride solution, 5% dextrose solution) in an amount that provides primary stabilization of the main hemodynamic parameters (2-3 l).

While maintaining the absorption function and peristalsis of the gastrointestinal tract, rehydration therapy is performed orally or through a thin gastric tube (alkaline-salt mixture, 5% dextrose solution in a volume of up to 2-3 liters per day).

Drug therapy: analgesics, sedatives, antihistamines, agents aimed at maintaining cardiac activity and respiration, oxygen inhalation.

To eliminate bronchospasm and reduce laryngeal edema in case of damage to the respiratory tract, corticosteroids are used (prednisolone – 60-120 mg intravenously), aminophylline. With symptoms of asphyxia and impaired bronchial patency, tracheostomy (conicotomy) is indicated.

Evacuation to a military hospital or the nearest specialized medical institution, on a stretcher by ambulance, accompanied by a doctor (paramedic), continuing emergency care.

electrical injury

The severity of electric shock depends on the strength of the current, the duration of exposure, the type of current, the area of contact with the current-carrying conductor, the path of the current through the body. The clinic is due to the predominant lesion of the heart, brain and spinal cord, parenchymal organs, burns.

Convulsive contractions of individual muscle groups, often turning into generalized convulsions, depression of consciousness of varying degrees. Respiratory and circulatory disorders up to the development of a terminal state. Dissections of tissues, avulsion and compression fractures of bones, and even separations of limbs are possible. In places of current entry and exit, there may be skin lesions of various shapes and sizes – from small areas of necrosis with a central impression (current marks) to significant IV degree burns or even charring of an entire limb.

First aid. Immediately release the victim from the action of electric current: turn off the switch, unscrew the fuse, cut the wires with an ax (shovel) with a wooden handle. When the victim cannot unclench his hands due to tonic contraction of the flexor muscles (“fixation of the limb”), he must be thrown back by any means from the current source, using improvised objects, because. the assisting person himself can be included in the electrical circuit or drag the victim by dry clothes, having previously secured himself (stand on a dry board or rubber). In case of cardiac and respiratory arrest – CPR (see “Clinical death (cardiopulmonary resuscitation)”).

First aid. In addition to first aid measures – with bradycardia – 0.5-1 ml of a 0.1% solution of atropine intramuscularly.

First aid. With preserved breathing and blood circulation, help should be provided as in case of collapse. In addition to first aid measures: antihistamines (2 ml of 1% diphenhydramine solution), sedatives (2-4 ml of 0.5% diazepam solution). Intravenous 400-500 ml of saline, 400-500 ml of 5% dextrose solution. oxygen inhalation. When breathing stops (typical for high voltage direct current damage) – mechanical ventilation. With the development of clinical death – CPR (see “Clinical death (cardiopulmonary resuscitation)”).

Evacuation to a military hospital or the nearest specialized medical institution, on a stretcher by ambulance, accompanied by a doctor (paramedic), continuing emergency care.

Frostbite

In the pre-reactive period (the period of tissue hypothermia) – numbness of the extremities, the skin of the affected area is pale and cyanotic, cold, a decrease or absence of all types of sensitivity, severe stiffness or glaciation of the extremities is possible. Diagnosis of the degree of frostbite in the pre-reactive period is impossible and is carried out only in the reactive period (after warming).

In the reactive period (after tissue warming), the skin in the affected areas becomes edematous, hyperemic, with cyanotic or marbled color. Itching, pain and tingling appear in frostbitten tissues (I degree), blisters are formed filled with transparent contents, the bottom of the blisters retains sensitivity to pricks or touches (II degree). The contents of the blisters can be dark hemorrhagic, and the bottom of the blisters is not sensitive to pain irritations and does not bleed during injections (III-IV degree). With frostbite of the IV degree, mummification of the dead segments occurs in 2-3 weeks.

First aid. Stop further cooling, remove wet clothing. The affected are warmed by available means (wraps, hot drinks, etc.). In pre-reactive, a heat-insulating bandage (cotton-gauze with a layer of gray cotton wool 5 cm thick) gives a good effect. Under these conditions, the tissue temperature is restored due to the heat brought by the blood flow. As the tissues are warmed “from the depths”, the blood flow in the distal parts of the limbs is restored, their temperature and the level of metabolic processes in the cells increase (with this method, warming the limbs takes from 5 to 10 hours).

First aid. A heat-insulating bandage should be applied or warming of the limbs in warm water (if possible, general warming in a warm bath) for 40-60 minutes should be applied. The water temperature rises gradually, starting from 25-30°C to 38-40°C. Warming should be accompanied by a light massage.

First aid. If necessary, the activities of the previous stage. After warming the limbs, the affected areas should be treated with alcohol, cotton-gauze dressings should be applied, intravenous infusion and drug therapy should be started (400-500 ml of warm 0.9% sodium chloride solution).

Evacuation to a military hospital or the nearest specialized medical institution, on a stretcher by ambulance, accompanied by a doctor (paramedic), continuing emergency care.

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