Initial Management - ABC’s

Treatment of the injured patient still depends on the ABC’s. First, ensure the presence of a patent airway. Second, confirm or support breathing. Third, confirm or support the circulatory system. “R” for radiation is at the other end of the alphabet. A dead, but decontaminated patient defeats the purpose of care. A living, but contaminated patient permits further intervention later when more stable.

Always stabilize the patient first. Care should never be delayed because of radiological considerations. Similarly, should a patient arrive at the hospital without prior notification, do not hesitate to perform lifesaving treatment just because the REA has not been prepared. Try to isolate the contamination as much as possible and then stabilize the patient. If staff are not familiar with the radiation procedures, tell them to treat the patient as a septic case. The principles of bacterial contamination and radiological contamination are very similar.

Contaminated clothing will commonly be removed at the scene of the injury. If not, emergency room personnel often remove all clothing to allow good visualization and physical examination of all body areas. The clothing should be handled as if it was contaminated and disposed of in a proper receptacle. This simple act of removing the clothing will result in the elimination of up to 90% of the contamination on a patient.

There are several clinical findings that might confuse the management of the patient if they are not known ahead of time.


The lay press and popular movies mention radiation burns in conjunction with radiation exposure. These do not usually occur until several hundred rem of exposure occurs. Furthermore, radiation burns never appear instantaneously. If you see a burn on a patient, it is either thermal or chemical in nature. Of course, radiation exposure may occur in conjunction with thermal or chemical burns. This will certainly affect the healing process.

Hair Loss

Another physical finding that is commonly perceived to be secondary to radiation effects is alopecia. Like burns, hair loss does not occur immediately and requires several hundred rem of exposure before it occurs. Hair loss, if seen on physical exam, will not be secondary to radiation exposure in the acute setting.

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