You are here: Home > Exposure: Diagnose/Manage Acute Radiation Syndrome > Text Version		Population Monitoring in Radiation Emergencies: A Guide for State and Local Public Health Planners, 8/2007 (HHS/CDC) HHS Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) Strategy and Implementation Plan (HHS) Medical Countermeasures Against Radiological and Nuclear Threats (NIH/NIAID)    New Users: Where Do I Start? Use REMM: Earn CME Patient Management Algorithms Print Algorithms & Tables Isotopes of Interest Countermeasures Decontamination Procedures Dose Estimator for Exposure Manage ARS Subsyndromes Hematopoietic Subsyndrome Cutaneous Radiation Syndrome  New! Time/Dose Effects in ARS Time Phases of ARS  New! Strategic National Stockpile Animations, Illustrations, Photos Dictionary Emergency Contacts Download REMM (7/2008) Download Mobile REMM (12/2008)    AFRRI AHRQ CDC CRCPD DHS DOE EPA FDA HHS   HPS IAEA ICRP NCRP NRC OSHA REAC/TS RITN WHO
	Exposure: Diagnose/Manage Acute Radiation Syndrome (Text Version) CAUTION 1 Algorithm guideline modifications will be required in mass casualty events. CAUTION 2 Surgery Burn treatment Blood products Estimate dose initially, if possible Otherwise, go to Clinical Management of Acute Radiation Syndrome I. Estimate Dose Initially, If Possible Estimate Exposure Dose Use Lab Data Lymphocyte depletion kinetics Chromosome analysis (dicentrics) and/or Use History Onset of vomiting Prodromal symptoms Dose reconstruction Dose > 2 Gy: Consider cytokines/stem cell growth factors Manage ARS hematopoietic subsyndrome based on dose, event size, and presence/absence of injury/burn Proceed to Clinical Management Dose ≤ 2 Gy, with significant injury/burn: Hold patient in health care facility for injury/burn treatment and further hematologic evaluation Register patient in long-term follow-up database Proceed to Clinical Management Dose ≤ 2 Gy, no significant injury/burn: Send home with follow-up instructions Register patient in long-term follow-up database Personal physician should check sequential CBCs with differential if whole-body dose between 0.25 - 2 Gy II. Clinical Management of Acute Radiation Syndrome (ARS) (What Is ARS?) Draw Blood to Estimate Dose Track serial CBCs with differential: Lymphocyte depletion kinetics Send blood for chromosome analysis (dicentrics) Targeted Physical Examination Look for signs of Acute Radiation Syndrome 4 Subsyndromes of ARS: Dx/Rx Repeat subsyndrome evaluation frequently Match treatment to signs and symptoms Consider hematopoietic stem cell transplant referral if: Labs and clinical signs warrant Resources available Plan for evolution of ARS over time If No Recovery: Deceased Exposure without contamination: no additional precaution Register data into event database Otherwise: Survival Register patient in long-term follow-up database Plan long-term follow-up considering Whole body dose received Immune status Risk/surveillance for subsequent malignancy Risk/mitigation of specific organ dysfunction

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