External Decontamination for Radiation Exposure 

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Gross decontamination is as follows ^{[1, 2, 3, 4]} :

Remove all patient clothing

Full-body irrigation

Emergent medical care takes priority over decontamination

The image below depicts gross decontamination

Secondary decontamination is as follows ^[1] :

Head-to-toe survey with radiation-detection device

Skin: Irrigation and cleansing of radioactive areas with mild soap and water

Mouth: Swab samples from oral cavity; remove dentures and foreign bodies; brush teeth, gums, and tongue; copious irrigation

Nose: Swab nares, blow nose, copious irrigation

Eyes: Anesthetize eye, swab conjunctiva, copious irrigation

Ears: Swab external canal; examine tympanic membrane for perforation, if intact then irrigate

Open wounds: Swab wounds, remove foreign bodies, copious irrigation, cover with waterproof dressing

Repeat survey with radiation-detection device, and irrigate if above threshold

In March 2015, filgrastim (Neupogen) was approved by the US Food and Drug Administration (FDA) to increase survival in patients acutely exposed to myelosuppressive doses of radiation (suspected or confirmed exposure to radiation >2 Gy). ^{[5, 6, 7]}

For more information on radiation injuries and decontamination, see the Medscape topics CBRNE – Radiation Emergencies and Radiation-Exposure Injuries.

Military Medical Operations. Armed Forces Radiobiology Research Institute. Bethesda, MD 20889-5603. Medical Management of Radiologic Casualties. Online Third Edition. June 2010. [Full Text].

[Guideline] The Medical Aspects of Radiation Incidents. Oak Ridge Institute for Science and Education. Available at http://orise.orau.gov/files/reacts/medical-aspects-of-radiation-incidents.pdf. Accessed: July 11, 2013.

Veenema TG, Thornton CP. Guidance in Managing Patients Following Radiation Events. Adv Emerg Nurs J. 2015 Jul-Sep. 37(3):197-208. [Medline].

Nair V, Karan DN, Makhani CS. Guidelines for medical management of nuclear/radiation emergencies. Med J Armed Forces India. 2017 Oct. 73 (4):388-393. [Medline].

Neupogen (filgrastim) [package insert]. Thousand Oaks, California: Amgen, Inc. March 2015. Available at [Full Text].

Singh VK, Hauer-Jensen M. γ-Tocotrienol as a Promising Countermeasure for Acute Radiation Syndrome: Current Status. Int J Mol Sci. 2016 May 3. 17 (5):[Medline]. [Full Text].

Singh VK, Romaine PL, Newman VL, Seed TM. Medical countermeasures for unwanted CBRN exposures: part II radiological and nuclear threats with review of recent countermeasure patents. Expert Opin Ther Pat. 2016 Dec. 26 (12):1399-1408. [Medline]. [Full Text].

Lars J Grimm, MD, MHS Assistant Professor, Department of Diagnostic Radiology, Duke University Medical Center

Disclosure: Nothing to disclose.

Scott D Weingart, MD Associate Clinical Professor and Director, Department of Critical Care, Department of Emergency Medicine, Mount Sinai School of Medicine

Scott D Weingart, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents’ Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Zygmunt F Dembek, PhD, MPH, MS, LHD Associate Professor, Department of Military and Emergency Medicine, Adjunct Assistant Professor, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine

Zygmunt F Dembek, PhD, MPH, MS, LHD is a member of the following medical societies: American Chemical Society, New York Academy of Sciences

Disclosure: Nothing to disclose.

External Decontamination for Radiation Exposure 

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