Intestinal form of acute radiation sickness clinic. Acute radiation sickness

In the clinical picture of radiation sickness, the individual sensitivity of the organism to the reaction is of great importance, however, the lesions mainly depend on the dose intensity and on the area of the irradiated area.

Depending on the radiation dose, 4 degrees of radiation sickness are distinguished in persons who have undergone timely and rational treatment:

I. (light) degree - 1-2 Gy

II. (average) degree - 2-4 Gr.

III. (severe) degree - 4-6 Gy

IV. (extremely severe) degree - 6-10 Gy

In recent years, it has been proposed to isolate the most acute or fulminant forms of ARS with intestinal (10-20 Gy), toxic (20-80 Gy) and cerebral (80 Gy and above) variants of the course.

There are 4 periods of radiation sickness

I. Primary reaction period . It begins immediately after irradiation, and the more intense the radiation exposure, the sooner the reaction occurs. Characteristic of this period is an excited or depressed state, headache, dizziness, nausea, vomiting, in severe cases it is indomitable. Diarrhea is always mixed with blood.

In connection with an increase in vascular permeability, there is hyperemia of the skin and a slight swelling of the subcutaneous tissue, and in case of severe damage, the integument is pale due to the development of collapse, loss of consciousness may occur. On the part of the nervous system, meningeal phenomena are noted: slight stiffness of the occiput, p. Kernig, pathological reflexes of Babinsky, Rossolimo, Gordon, general hyperesthesia of the skin. Lethargy, drowsiness, weakness, tremor of the hands, sweating of the extremities, chills.

Thus, in the initial period of radiation sickness, functional reactions of overexcitation predominate. The duration of the I period is from several hours to 2-3 days. It should be noted the early development of lymphopenia already on the first day after irradiation, which is an early diagnostic sign.

II period (period of imaginary well-being). Complaints of patients decrease, health becomes satisfactory, lability of the pulse, blood pressure, malaise, asthenia may persist. The disease progresses, which can be traced by changes in the peripheral blood, leukocytosis is gradually replaced by leukopenia by 5-7 days with the development of neutropenia, and anemia occurs. The duration of the second period is from several days to 2-4 weeks, but in severe cases it may be completely absent and the first period directly passes into the third.

III period - the peak period of pronounced clinical phenomena.

It develops depending on the degree of damage after 1-3 weeks from the onset of the disease, in the most severe cases immediately after the initial periods. The main clinic of the disease is revealed, the features of the general toxic effect of radiation on the body, nervous system and hematopoiesis are determined. During this period, disturbances from the central nervous system intensify, headaches that are difficult to treat, sleep disturbances, dizziness, nausea, and vomiting resume. The decrease in reflexes begins to be clearly defined. There may be hemorrhages in various parts of the brain. The skin is dry, flaky, in severe cases, erythema appears with the formation of blisters, followed by decay and the development of gangrene. Baldness is a common symptom. Epilation begins in the second or third week after the lesion. The addition of a secondary infection is characteristic, which occurs as a result of the immune defenselessness of the body due to a sharp violation of hematopoiesis; possible development of sepsis.

Almost always there is a fever, often develops necrotic tonsillitis, gingivitis, stomatitis. Necrosis can be in the intestinal mucosa, which causes abdominal pain, diarrhea with blood. During this period, the inhibition of hematopoiesis progresses, general weakness and hemorrhagic phenomena increase, the permeability of the vascular walls is disturbed, and the amount of prothrombin decreases. Hemorrhagic syndrome manifests itself in the form of skin rashes and hemorrhages of various sizes and shapes, as well as in the form of bleeding (gastric, intestinal, pulmonary, nasal). Symptoms of damage to the cardiovascular system, primarily myocardium, may develop (tachycardia, hypotension, shortness of breath, expansion of the boundaries of the heart, systolic murmur at the apex, ECG changes), impaired liver and kidney function. Tissue decay reaches a high degree, which manifests itself in a negative nitrogen balance.

The endocrine glands, especially the sex glands, the pituitary gland and the adrenal glands (hypofunction), are also subject to change.

Changes occurring in the sex glands lead to sterility. The trophism is significantly disturbed. The third period lasts 2-4 weeks, after which, with a favorable course, it passes into the 4th period.

Radiation sickness - a kind of general disease that develops as a result of the damaging effects of ionizing radiation on the body .

Distinguish acute and chronic radiation sickness.

The modern classification of acute radiation sickness is based on the dependence of the severity and form of damage on the received radiation dose, firmly established in the experiment and in the clinic.

Acute radiation sickness- a nosological form that develops with external gamma and gamma-neutron irradiation at a dose exceeding 1 gray (Gy) (1 Gy = 100 rad), received at one time or within a short period of time (from 3 to 10 days), as well as with ingestion of radionuclides that create an adequate absorbed dose.

The primary action of radiation is realized in physical, physico-chemical and chemical processes with the formation of chemically active free radicals (H +, OH-, water), which have high oxidizing and reducing properties. Subsequently, various peroxide compounds (hydrogen peroxide, etc.) are formed. Oxidizing radicals and peroxides inhibit the activity of some enzymes and increase others. As a result, secondary radiobiological effects occur at various levels of biological integration.

Violations of the physiological regeneration of cells and tissues, as well as changes in the function of regulatory systems, are of primary importance in the development of radiation injuries. Great sensitivity to the action of ionizing radiation of hematopoietic tissue, intestinal epithelium and skin, spermatogenic epithelium has been proven. Muscle and bone tissues are less radiosensitive. High radiosensitivity in physiological terms, but relatively low radiosensitivity in anatomical terms, are characteristic of the nervous system.

Various clinical forms of ARS are characterized by certain leading pathogenetic mechanisms of the formation of the pathological process and their corresponding clinical syndromes.

By severity distinguish four degreesacute radiation sickness :

I - mild (irradiation dose 1-2 Gy)

II - moderate (irradiation dose 2-4 Gy);

Ш - severe (irradiation dose 4-6 Gy);

IV - extremely severe (irradiation dose over 6 Gy).

Acute radiation sickness I degree characterized by mild clinical manifestations.

· The initial reaction may be a single vomiting, mild weakness, minor headache and leukocytosis.

· Latent period lasts up to 5 weeks.

· During the period of peak there is a deterioration in health and moderate changes in the blood system (the number of leukocytes decreases to 3-10 9 / l) and the activity of other physiological systems.

Usually, by the end of the 2nd month, patients have a complete recovery of combat and working capacity.

In acute radiation sickness II degree the periods of the disease are clearly expressed, but the affected patients do not have a severe general condition.

The primary reaction lasts up to 1 day. There are nausea and 2-fold or 3-fold vomiting, general weakness, subfebrile body temperature.

Latent period 3-4 weeks.

· At the height of the disease, the level of leukocytes decreases only to 1.8-0.8-10 9 /l. Baldness is pronounced, hemorrhagic manifestations are moderate (skin petechiae, nosebleeds are possible).

There are no necrotic changes in the pharynx and gastrointestinal tract.

Severe infectious complications are rare.

In half of the cases, after 2-3 months, combat and work capacity is fully restored.

Acute radiation sickness III degree runs hard.

· Violent primary reaction 30-60 minutes after irradiation, lasts up to 2 days, nausea, repeated vomiting, general weakness, subfebrile body temperature, headache.

· The development of dyspeptic syndrome already in the first tens of minutes and the early appearance of diarrhea indicate exposure to a dose of more than 6 Gy.

Latent period - 10-15 days, but weakness remains.

Hair falls out early.

Lymphocytopenia and thrombocytopenia rapidly increase, the number of leukocytes decreases sharply (up to 0.5-10 9 / l and below), agranulocytosis develops, sometimes severe anemia,

Multiple hemorrhages, necrotic changes, infectious complications and sepsis appear.

The prognosis is serious, but not hopeless.

Acute radiation sickness IV degree:

· The primary reaction already from the moment of irradiation proceeds extremely violently, lasts 3-4 days, is accompanied by indomitable vomiting and severe weakness, reaching adynamia.

Possible general skin erythema, loose stools, collapse, psychomotor disorder, early hematopoiesis.

The prognosis is unfavorable.

In the most acute, "lightning" form (irradiation dose of 10-100 Gy), death occurs within 1-3 to 8-12 days.

With an increase in the dose and power of radiation, the clinical manifestations of the disease intensify. With uneven exposure to radiation, the most severe forms of the disease develop after irradiation of the abdominal organs.

Depending on the possible manifestations, there are bone marrow, intestinal, toxic and cerebral forms of ARS .

Bone marrow form - a typical form of ARS, occurs frequently, develops with irradiation at a dose of 1-10 Gy. The leading symptom in the clinical picture of the disease is a violation of hematopoiesis.

The course of the bone marrow form of radiation sickness is characterized by a certain cyclicity, undulation, in connection with which the following are distinguished four periods , which are especially characteristic of moderate and severe:

· common primary response ;

· latent, or relative clinical well-being ;

· swing , or pronounced clinical manifestations;

· recovery .

Total Primary Response Period begins immediately or several hours after irradiation. Usually, the earlier signs of a primary reaction appear and the longer it lasts, the more severe the radiation sickness is.

The main symptoms of the primary reaction:

Nausea and vomiting (multiple in severe cases)

general weakness, headache and dizziness.

· Appearing at first slight psychomotor agitation is soon replaced by depression of the psyche, lethargy.

Often patients are concerned about thirst and dry mouth.

Body temperature is usually normal or moderately elevated.

Signs of instability of the autonomic nervous system (tachycardia, fluctuations in blood pressure, hyperhidrosis, hyperemia and some puffiness of the skin of the face) are noted.

In the most severe cases (super-lethal exposure), shortness of breath, diarrhea, pronounced cerebral symptoms up to loss of consciousness, complete prostration, convulsions and a shock-like state are observed.

· typical for the primary reaction neutrophilic leukocytosis (10-20 -10 9 /l) with a shift to the left, as well as a mild decrease in the number of lymphocytes. Leukocytosis can be replaced by leukopenia after a few hours.

There are shifts in various types of metabolism.

The primary reaction lasts from several hours to 2 days, then its manifestations subside and the second period begins.

Latent period (hidden), or relative clinical well-being , is characterized mainly by:

improvement of well-being,

The disappearance of some painful manifestations of the primary reaction (nausea and vomiting, headache).

However, blood changes are clearly expressed: Leukopenia increases (up to 3-1.5-10 9 / l), it becomes persistent, thrombocytopenia gradually increases, reticulocytes almost completely disappear from the peripheral blood, and erythrocytes change degeneratively.

· In the bone marrow begins to develop hypoplasia - a sign of oppression of hematopoiesis.

Qualitatively altered cells appear in the peripheral blood: hypersegmentation of neutrophil nuclei, their toxic granularity, anisocytosis, poikilocytosis, etc.

The most important for diagnosis and prognosis is the depth of lymphocytopenia on the 3-4th day of the disease.

· Latent period, as a rule, lasts 2-4 weeks; in mild forms - up to 5 weeks, in extremely severe forms it may be absent. The more severe the lesion, the shorter the latent period, and vice versa.

peak period, or pronounced clinical manifestations :

The timing of the peak period and its duration depend on the severity of ARS:

1 tbsp. comes on the 30th day, lasts 10 days;

2 tbsp. comes on the 20th, lasts 15 days;

3 tbsp. comes on the 10th, lasts 30 days;

4 tbsp. occurs on days 4-8, death occurs on 3-6 weeks.

· The clinical transition from the latent period to the peak period occurs abruptly (excluding mild degrees), begins with a deterioration in well-being and is characterized by a polymorphic clinical picture.

General weakness increases, appetite disappears, body temperature rises and, depending on the severity of the disease, varies from subfebrile to hectic.

Trophic phenomena develop: hair falls out, the skin becomes dry, flaky; edema sometimes appears on the face, hands and feet.

Characterized by the development of hemorrhagic syndrome (subcutaneous hemorrhage, nasal, gastric and uterine bleeding), ulcerative necrotic changes (stomatitis, conjunctivitis), infectious complications (bronchitis, pneumonia, cystitis, pyelitis). In severe cases, abdominal pain and diarrhea may occur.

Sometimes the disease proceeds according to the type of sepsis.

In the midst of the disease, the oppression of the blood system reaches a particularly sharp degree. First of all, the content of leukocytes decreases (up to 2-1-10 9 /l), sometimes agranulocytosis develops (the number of leukocytes is below 1-10 9 /l), anemia increases. All this is a consequence of the oppression or almost complete cessation of bone marrow hematopoiesis.

· Pronounced changes in the blood coagulation system, which contributes to the development of hemorrhagic syndrome, the main factor of which is thrombocytopenia (below 5-10 10 /l).

The peak period lasts 2-4 weeks.

Recovery period Depending on the severity of the disease, it lasts from one to several months.

Usually the transition to recovery is gradual. For a long time, signs of asthenia, vegetative-vascular instability and functional disorders in the activity of a number of organs and physiological systems of the body (gastrointestinal dyskinesias, chronic gastritis, enterocolitis, certain disorders in the blood system) persist.

One of the first objective signs of the onset of the recovery period is appearance of reticulocytes in the blood. Sometimes their number reaches 70 per 1000 erythrocytes, which is considered as a kind of reticulocyte crisis.

An increase in the number of monocytes and eosinophils in the blood can be noted; the level of platelets is restored quite quickly. At the same time, the content of leukocytes gradually increases (sometimes for some period even above the norm).

In a number of patients after acute radiation sickness, somatic and genetic consequences . To somatic consequences include a reduction in life expectancy, the development of cataracts (in 30-40% of cases), more frequent development of leukemia and malignant neoplasms. According to the literature, leukemia in those affected as a result of an atomic explosion is observed 5-7 times more often than in those who have not been exposed to radiation. To genetic consequences include various deformities found in descendants, mental disability, congenital diseases, etc.

The severity of the manifestations of the disease and the duration of individual periods are determined by the severity of radiation exposure.

Acute radiation sicknessin some cases, it can occur with simultaneous external exposure to radiation and internal radioactive contamination (combined radiation injury).

1. And in these cases, the dose of external radiation will be of decisive importance. However, the clinical picture will additionally reveal signs of damage to the organs of the digestive apparatus (gastroenteritis, liver damage).

2. When RVs deposited in the bone tissue (strontium, plutonium) are ingested, pathological changes often develop in the bones and may not occur immediately, but after many months and years.

3. Diagnosis of internal radioactive contamination is established by radiometric examination of urine, feces, blood, as well as by external dosimetry, which allows recording the radiation of the affected body after sanitization.

4. Radiometry in the area of the thyroid gland is of particular value.

More severe forms of ARS (intestinal, toxemic, cerebral) in humans are not well understood.

intestinal form

Irradiation at a dose of 10 to 20 Gy leads to the development of radiation sickness, the clinical picture of which is dominated by signs of enteritis and toxemia due to radiation damage to the intestinal epithelium, a violation of the barrier function of the intestinal wall for microflora and bacterial toxins.

The primary reaction develops in the first minutes, lasts 3-4 days. Multiple vomiting appears in the first 15-30 minutes. Characterized by abdominal pain, chills, fever, arterial hypotension. Often on the first day there is loose stools, later enteritis and dynamic intestinal obstruction are possible. In the first 4–7 days, the oropharyngeal syndrome is pronounced in the form of ulcerative stomatitis, necrosis of the oral mucosa and pharynx. From 5-8 days the condition deteriorates sharply: high body temperature, severe enteritis, dehydration, general intoxication, infectious complications, bleeding. Lethal outcome on 8 - 16 days.

Histological examination of the dead on days 10-16 shows a complete loss of the intestinal epithelium, due to the cessation of physiological cell regeneration. The main cause of mortality is due to early radiation damage to the small intestine (intestinal syndrome).

Similar information.

Acute radiation sickness (ARS) is a one-time injury to all organs and systems of the body, but above all, acute damage to the hereditary structures of dividing cells, mainly hematopoietic cells of the bone marrow, lymphatic system, epithelium of the gastrointestinal tract and skin, cells of the liver, lungs and other organs as a result of exposure to ionizing radiation.

Being an injury, radiation damage to biological structures is strictly quantitative in nature, i.e. small impacts may be imperceptible, large ones can cause disastrous lesions. The radiation dose rate also plays a significant role: the same amount of radiation energy absorbed by the cell causes the greater damage to biological structures, the shorter the exposure period. Large doses of exposure, extended over time, cause significantly less damage than the same doses absorbed in a short time.

The main characteristics of radiation damage are thus the following two: the biological and clinical effect is determined by the radiation dose (“dose-effect”), on the one hand, and on the other hand, this effect is also determined by the dose rate (“dose-effect”).

Immediately after irradiation of a person, the clinical picture is poor, sometimes there are no symptoms at all. That is why knowledge of the human exposure dose plays a decisive role in the diagnosis and early prediction of the course of acute radiation sickness, in determining therapeutic tactics before the development of the main symptoms of the disease.

In accordance with the dose of radiation exposure, acute radiation sickness is usually divided into 4 degrees of severity: mild (irradiation dose in the range of 1-2 Gy), medium (2-4 Gy), severe (4-6 Gy) and extremely severe (6 Gy) . When irradiated at a dose of less than 1 Gy, they speak of acute radiation injury without signs of disease, although slight changes in the blood in the form of transient moderate leukocytopenia and thrombocytopenia approximately one and a half months after exposure, some asthenia may be. In itself, the division of patients according to degrees of severity is very conditional and pursues the specific goals of sorting patients and carrying out specific organizational and therapeutic measures in relation to them.

The system for determining dose loads using biological (clinical and laboratory) indicators in victims under the influence of ionizing radiation was called biological dosimetry. At the same time, this is not about true dosimetry, not about calculating the amount of radiation energy absorbed by tissues, but about the correspondence of certain biological changes to the approximate dose of short-term, one-time general irradiation; This method allows you to determine the severity of the disease.

The clinical picture of acute radiation sickness, depending on the radiation dose, varies from almost asymptomatic at doses of about 1 Gy to extremely severe from the first minutes after exposure at doses of 30-50 Gy or more. At doses of 4-5 Gy of total irradiation of the body, practically all the symptoms characteristic of acute radiation sickness of a person will develop, but less or more pronounced, appearing later or earlier at lower or higher doses. Immediately after irradiation, the so-called primary reaction appears. Symptoms of the primary reaction to irradiation consist of nausea and vomiting (30-90 minutes after irradiation), headache, and weakness. At doses less than 1.5 Gy, these phenomena may be absent, at higher doses they occur and their severity is greater, the higher the dose. Nausea, which may be limited to the primary reaction in a mild disease, is replaced by vomiting, with an increase in the dose of radiation, vomiting becomes multiple. This dependence is somewhat violated when radionuclides are incorporated due to irradiation from a radioactive cloud: vomiting can be repeated, persistent even at a dose close to 2 Gy. Sometimes victims note a metallic taste in the mouth. At doses above 4-6 Gy of external irradiation, transient hyperemia of the skin and mucous membranes, swelling of the mucous membrane of the cheeks, tongue with light imprints of teeth on it occur. When irradiated from a radioactive cloud. when the skin and mucous membranes are simultaneously affected by the j and b components, with inhalation of radioactive gases and aerosols, early onset of nasopharyngitis, conjunctivitis, radiation erythema is possible, even with developing acute mild radiation sickness.

Gradually - within a few hours - the manifestations of the primary reaction subside: vomiting ends, headache decreases, hyperemia of the skin and mucous membranes disappears. The state of health of patients improves, although severe asthenia and very rapid fatigue remain. If external exposure was combined with the ingestion of radionuclides that directly affect the mucous membrane of the respiratory tract and intestines, then in the first days after exposure, there may be loose stools several times a day.

All these phenomena pass in the coming days, but after a certain period of time they reappear as the main and very dangerous signs of acute radiation sickness. At the same time, in addition to quantitative relationships between dose and effect, there is another phenomenon characteristic of radiation injuries between dose rate and effect: the higher the dose, the earlier the specific biological effect will be. This phenomenon lies in the fact that vomiting, specific for the primary reaction, occurs earlier at a high dose, the main signs of the disease are: radiation stomatitis, enteritis, a drop in the number of leukocytes, platelets, reticulocytes with all their regularities, epilation, skin lesions, etc. - appear the earlier, the higher the dose. The described phenomenon is called the "dose - time of effect" dependence, it plays an important role in biological dosimetry.

In many victims without a strict dependence on the dose, a transient enlargement of the spleen can be noted in the first days of the disease. The decay of red bone marrow cells may be due to mild icterus of the sclera and an increase in the level of indirect bilirubin in the blood, noticeable on the same days, then disappearing.

Forms of acute radiation sickness

ARS with a primary lesion of the blood system

Doses above 100 r cause a bone marrow form of ARS of varying severity, in which the main manifestations and outcome of L. b. depend mainly on the degree of damage to the hematopoietic organs. Doses of a single total exposure over 600 r are considered absolutely lethal; death occurs within 1 to 2 months after irradiation. At the most typical form of acute L. b. at first, after a few minutes or hours, those who received a dose of more than 200 r experience primary reactions (nausea, vomiting, general weakness). After 3-4 days, the symptoms subside, a period of imaginary well-being begins. However, a thorough clinical examination reveals the further development of the disease. This period lasts from 14-15 days to 4-5 weeks. Subsequently, the general condition worsens, weakness increases, hemorrhages appear, body temperature rises. The number of leukocytes in the peripheral blood after a short-term increase progressively decreases, falling (due to damage to the hematopoietic organs) to extremely low numbers (radiation leukopenia), which predisposes to the development of sepsis and hemorrhages. The duration of this period is 2-3 weeks.

ARS with a primary lesion of the gastrointestinal tract (intestinal form)

With general irradiation in doses from 1000 to 5000 r, the intestinal form of L. develops. It is characterized mainly by intestinal damage, leading to impaired water-salt metabolism (from profuse diarrhea), and circulatory disorders. Manifestations are observed in the form of radiation stomatitis, gastritis, colitis, eosophagitis, etc. A person with this form usually dies during the first day, bypassing the usual phases of L.'s development.

ARS with a predominant CNS lesion (cerebral form)

After total irradiation in doses above 5000 r, death occurs in 1-3 days or even at the time of irradiation itself from damage to the brain tissues (this form of l. b. is called cerebral). This form of the disease is manifested by cerebral symptoms: workload; rapid exhaustion, then confusion and loss of consciousness. Patients die with symptoms of cerebral coma in the first hours after irradiation.

ARS in victims of accidents at reactors and nuclear power plants

In case of accidents at experimental reactor facilities, when irradiation is determined by the lightning-fast formation of a critical mass, a powerful flux of neutrons and gamma rays, when the irradiation of the victim's body lasts a fraction of a second and breaks off by itself, the personnel must immediately leave the reactor hall. Regardless of the state of health of the victims, all those who were in this room should be immediately sent to the health center or immediately to the medical unit if it is located at a distance of several minutes from the accident site. With an extremely severe degree of damage, vomiting can begin within a few minutes after exposure, and moving in a car will provoke it. In this regard, if the hospital is not close to the accident site, it is possible to transfer the victims there even after the end of the primary reaction, leaving them in the medical unit for the time of vomiting. Victims with severe lesions should be placed in separate rooms so that the sight of vomiting in one does not provoke it in another.

After the end of vomiting, all victims should be transported to a specialized clinic.

In explosions of nuclear and thermonuclear bombs, accidents at industrial facilities with the release of radioactive gases and aerosols, due to the release of unstable isotopes, the actions are somewhat different. First, all personnel should leave the affected area as soon as possible. For a sharp increase in the dose of radiation, extra seconds of staying in a cloud of aerosols and gases matter. Many isotopes of radioactive gases and aerosols have a half-life calculated in seconds, i.e. they "live", a very short time. This explains the seemingly strange fact of a completely different degree of damage in persons who were in an emergency situation almost nearby, but with a small (for them often imperceptible) difference in time. All personnel must be aware that it is strictly forbidden to pick up any objects located in the emergency room, you can not sit on anything in this room. Contact with objects heavily contaminated with j-, b-emitters will lead to local radiation burns.

In the event of an accident, all emergency building personnel should immediately put on respirators, take a potassium iodide tablet as soon as possible (or drink three drops of iodine tincture diluted in a glass of water), since radioactive iodine accounts for a significant amount of radiation activity.

After leaving the emergency room, the victims are thoroughly washed with soap under the shower. All their clothes are seized and subjected to dosimetric control.

Dress the victims in different clothes. The question of the duration of washing and cutting hair is decided according to the data of dosimetric control. Everyone is immediately given adsobar. The appearance of diarrhea in the near future after the accident is associated with the intake of potassium iodide (it can indeed provoke diarrhea in some people). However, as a rule, diarrhea in the first days after exposure from a radioactive cloud is due to radiation damage to the mucous membrane of the gastrointestinal tract.

Treatment of ARS at the stages of evacuation, in peacetime and wartime

Due to the fact that accidents at nuclear power plants, conflicts with the use of nuclear weapons are characterized by massive sanitary losses, the first place in the organization of the LEM is the sorting of the affected.

Primary triage for upcoming hospitalization or outpatient follow-up

1. Irradiation without the development of signs of the disease (irradiation dose up to 1 Gy) and/or mild acute radiation sickness (ARS) severity (1 - 2 Gy). Patients do not need special treatment, only outpatient monitoring is necessary. Patients can be left (with the exclusion of additional exposure) in place or assigned to a local medical facility closest to the accident zone (accommodation).
2. Acute radiation sickness of moderate degree severity (1 - 2 Gy). Early initiation of specialized treatment ensures survival.
3. Acute severe radiation sickness gravity (4 - 6 Gy). Survival of patients with timely treatment is likely.
4. Acute radiation sickness of extremely severe degree(more than 6 Gy). Survival during treatment is possible in isolated cases. Tactics in relation to this group of patients differs in mass lesions and small incidents.

The division of ARS according to severity, based on dose loads, and not on the nature and severity of the painful manifestations themselves, makes it possible, first of all, to save people with an injury dose of less than 1 Gy from hospitalization. Only persons with severe lesions, when the radiation dose exceeds 4 Gy, require immediate hospitalization in a specialized hematological hospital, as they develop agranulocytosis, deep thrombocytopenia, necrotic enteropathy, stomatitis, radiation damage to the skin and internal organs in the coming days or weeks after exposure. . Agranulocytosis also develops in ARS of moderate severity, therefore, such victims also require hospitalization, but in case of a massive lesion, in exceptional cases, it can be postponed for 2 weeks.

First medical and pre-hospital care are described above, in connection with this, we will consider the scope of measures for qualified and specialized care.

In case of severe and extremely severe radiation injury, emergency care may be required due to the occurrence of a primary reaction, due to the severity of its manifestations, which are not characteristic of the primary reaction with general irradiation of mild and moderate severity. Such manifestations include, first of all, repeated vomiting that occurs after 15-30 minutes. after irradiation (with prolonged exposure, vomiting may occur later). It should be tried to interrupt and alleviate it with intramuscular or intravenous administration of 2 ml (10 mg) of metoclopramide (cerucal, raglan), taking it in tablets with vomiting is pointless. Intravenously, the drug is administered either drip or very slowly (10-30 minutes), which increases its effectiveness. Possible and appropriate in the case of recurrent vomiting, repeated administration of metoclopramide every 2 hours.

To reduce vomiting, you can enter 0.5 ml of a 0.1% solution of atropine subcutaneously or intramuscularly. If vomiting becomes indomitable due to developing hypochloremia, it is necessary to inject 30-50 (up to 100) ml of 10% (hypertonic) sodium chloride solution intravenously. After that, you need to forbid the patient to drink for several hours. To eliminate dehydration caused by repeated or indomitable vomiting, saline solutions should be administered intravenously: either an isotonic sodium chloride solution (500-1000 ml) intravenously or, in extreme cases, subcutaneously, or 500-1000 ml of Trisol solution (5 g of sodium chloride, 4 g of sodium bicarbonate and 1 g of potassium chloride per 1 liter of water, it is conventionally sometimes called a 5:4: 1 solution), or 1000 ml of a 5% glucose solution with 1.5 g of potassium chloride and 4 g of sodium bicarbonate.

With fractionated total irradiation at a dose of 10 Gy (for bone marrow transplantation, for example), neuroleptics and sedatives are used to reduce vomiting and nausea, which develop even with low power irradiation. More often, aminazine (chlorpromazine) is used at a dose of 10 mg / m2 (2.5% solution in ampoules of 1.2 or 5 ml, i.e. 25 mg per 1 ml) and phenobarbital (luminal) at a dose of 60 mg / m2 ( powder or tablets of 0.05 and OD g). These drugs are administered repeatedly, chlorpromazine intravenously. However, their use outside the hospital and in case of mass radiation injury, as well as haloperidol (intramuscularly 0.4 ml of a 0.5% solution) or droperidol (1 ml of a 0.25% solution) is excluded, since it requires constant monitoring of blood pressure, which without them use in extremely severe primary reactions to radiation may be reduced. During this period, the liquid is injected every 4 and 1 liter, then (after 24 and such a regimen) every 8 hours, alternating the Trisol solution and 5% glucose solution with potassium chloride and sodium bicarbonate (1.5 and 4 g, respectively, per 1 liter of glucose) .

The introduction of liquids reduces the intoxication caused by massive cellular decay. For the same purpose, it is advisable to use plasmapheresis in an extremely severe primary reaction, replacing the removed plasma with saline solutions (see above), 10% albumin solution (100.200 ml to 600 ml).

Cellular decay can cause DIC - thickening of the blood, its rapid clotting in the needle during vein puncture, or the appearance of hemorrhagic rashes in the subcutaneous tissue, despite the initially normal platelet level, which does not decrease in the first hours and days of ARS. In this case, jet administration of fresh frozen plasma (60 drops per minute) 600-1000 ml, heparin administration (intravenous drip at the rate of 500-1000 U/h or 5000 U under the skin of the abdominal wall 3 times a day), as well as plasmapheresis.

An extremely severe degree of ARS may be accompanied by the development of collapse or shock, confusion due to cerebral edema. With a collapse caused by redistribution of fluid in the tissues and hypovolemia, it is enough to force the introduction of fluid, for example, saline solutions or a solution of 5% glucose at the rate of 125 ml / min (1-2 l in total), and intramuscular administration of cordiamine (2 ml), with bradycardia 0.5 ml of a 0.1% solution of atropine is injected. Reopoliglyukin can also be used to eliminate hypovolemia; as a disaggregant, it also reduces hypercoagulability. However, with cerebral edema, rheopolyglucin should be used with caution, as it can increase it. With cerebral edema, diuretics are used (40-80 mg of Lasix intravenously or intramuscularly), the drug is administered under the control of blood pressure. To eliminate cerebral edema, 60-90 mg of prednisolone can be administered intravenously. Hypertonic glucose solution (40%) should be used cautiously for this purpose, since by causing hypervolemia, it can increase cerebral edema. In the event of cerebral edema, as in other phenomena of severe intoxication caused by cell decay, it is advisable to carry out plasmapheresis.

If the patient develops shock, then anti-shock measures are necessary: intravenous administration of large doses of prednisolone - up to 10 mg / kg hydrocortisone - up to 100 mg / kg, anti-shock fluids under the control of CVP (norm 50-120 mm of water column), dopamine (under blood pressure control), 5-10% albumin solution - from 200 to 600 ml. Since any shock is accompanied by DIC or develops in connection with it, it is also necessary to use drugs to stop DIC (see above).

Emergency care may become necessary during the development of the hematological syndrome, its main manifestation is myelotoxic agranulocytase. During this period, such life-threatening complications as sepsis and septic shock, necrotic enteropathy and septic shock, or bleeding and hemorrhagic shock, DIC are possible.

In the treatment of sepsis and septic shock, the main thing is to suppress the microflora that caused it. In the first few days, parenteral administration of large doses of highly active broad-spectrum antibiotics (from the group of semi-synthetic penicillins or cephalosporins and aminoglycosides) is necessary, then, when the pathogen is identified, targeted drugs: for pneumococcal sepsis, large doses of penicillin; with Pseudomonas aeruginosa sepsis - carbenicillin (30 g per day) in combination with aminoglycosides (gentamicin or amikacin 240 mg / day or 300 mg / day, respectively); with staphylococcal sepsis - cefamesin 4-6 g / day; with fungal sepsis - amphoteracin-B (intravenously at the rate of 250 units / kg), nystatin and nazoral inside. At the same time, gamma globulin (endobulin, gammammune, sandobulin) must be administered intravenously at a dose of 1/10 kg once every 7-10 days. In the treatment of sepsis, plasmapheresis is used, which activates phagocytosis (primarily spleen macrophages). The use of fresh frozen plasma and heparin for the relief of DIC complicating sepsis makes it possible to cope with local lesions: necrotic enteropathy, tissue necrosis, liver and kidney failure.

Local purulent processes, more often foci of necrosis, since we are talking about lesions in the period of agranulocytosis, can be stopped by applying 4 times a day a 10-20% solution of dimexide with an anti-iotik, to which the microflora isolated from the focus is sensitive, or with a broad-spectrum antibiotic ( in daily dose).

In the case of the development of necrotic enteropathy as a complication of agranulocytosis or as an independent process - an intestinal syndrome caused by radiation damage to the small intestine, first of all, complete fasting is necessary, it is allowed to drink only boiled water, but not tea or juices, etc. Salt solutions are administered intravenously, and it is possible, but not strictly necessary, to administer parenteral nutrition 15DO-2500 kcal / day. To suppress the infection, which is easily complicated by sepsis in necrotic enteropathy in conditions of agranulocytosis, intensive parenteral (only intravenous administration of drugs is allowed due to agranulocytosis) antibiotic therapy (see above treatment of sepsis). Along with it, non-absorbable antibiotics are used orally, more often vibramycin, kanamycin or polymyxin, or biseptol (6 tablets per day) and nystatin (6-10 million units / day).

In hemorrhagic syndrome, usually caused by thrombocytopenia, platelet mass is transfused in 4 doses (1 dose, sometimes called a unit, is 0.7.1011 cells), in just one procedure, about 3.1011 cells 2 times a week, and more often if necessary. In case of bleeding, a jet (60 drops per minute under CVP control) infusion of 600-1000 ml of freshly frozen plasma is necessary, as well as platelet transfusion.

Combined radiation injuries. Principles of treatment

In connection with the very nature of ARS, the occurrence of which is associated with emergency situations, the use of nuclear weapons, accidents at reactor facilities, terrorist attacks, is perhaps the most diverse combination of ARS and other pathologies complicating its course. Here are some of them:

Traumatic injuries. Fractures. bruises.
Traumatic brain injury.
Gunshot wounds.
Burns. Temperature and acid-base.
Defeat SDYAV.
Diseases of the internal organs.
Infectious diseases.
Psychiatric pathology.

All these diseases are combined with ARS both independently and in combination, making its course more difficult. However, despite this, the principles of ARS treatment are preserved, the tactics of treating these diseases are somewhat changed. We should remember that at the end of the primary reaction in patients, a period of well-being begins, ending in a few days with the onset of pronounced clinical manifestations. Therefore, all traumatic surgical procedures for the patient should be performed immediately after the end of the primary reaction period or during it. When prescribing pharmacological drugs, one should avoid prescribing drugs that suppress hematopoiesis: NSAIDs, some antibiotics, glucocorticoids, cytostatics, etc.

CLINIC OF ACUTE RADIATION SICKNESS

Parameter name	Meaning
Article subject:	CLINIC OF ACUTE RADIATION SICKNESS
Rubric (thematic category)	Radio

CLASSIFICATION OF ACUTE RADIATION SICKNESS

ACUTE RADIATION SICKNESS

Acute radiation sickness (ARS) is a disease resulting from short-term (from several minutes to 1-3 days) exposure of the entire body or most of it to ionizing radiation (gamma rays, neutrons, X-rays) in a dose exceeding 1 Gy , and characterized by phasic flow and polymorphism of clinical manifestations (Table 1). Taking into account the dependence on the dose of external radiation, cerebral, toxemic, gastrointestinal and typical, or bone marrow, forms of acute radiation sickness are distinguished.

The cerebral form of ARS occurs with total exposure to a dose of more than 80-100 Gy. In this case, direct damage to the central nervous system occurs with a profound violation of its functions. Severe psychomotor agitation, disorientation occur, followed by adynamia, respiratory and circulatory disorders, convulsions. Victims die during the first hours after irradiation.

The toxemic form of ARS develops at radiation doses of 50-80 Gy. Due to severe intoxication with tissue metabolism products, the affected also experience severe impairment of the functional state of the central nervous system. Death occurs within the first 3-8 days after the defeat.

The gastrointestinal form of ARS develops with irradiation at a dose of 10-50 Gy. The victims are dominated by severe gastrointestinal disorders - indomitable vomiting, diarrhea, tenesmus, paresis of the stomach and intestines. This form of the disease usually ends in death within 5-10 days from the moment of exposure.

The bone marrow (typical) form of ARS occurs at radiation doses of 1-10 Gy and, in connection with the real prospects for recovery, is of the greatest practical importance. The main pathogenetic and clinical changes are pathological changes in the blood system (cytopenia, clotting disorders), hemorrhagic syndrome, infectious complications.

Acute radiation exposure in doses less than 1 Gy does not lead to the development of radiation sickness, but manifests itself in the form of a radiation reaction at 4-6 weeks.

In the pathogenesis of radiation sickness, the following points are important: 1) direct and indirect effects of ionizing radiation on the cells and tissues of an irradiated organism with maximum damage to radiosensitive elements (lymphoid, myeloid tissue; germinal, intestinal and integumentary epithelium; secretory cells of the digestive and endocrine glands ); 2) metabolic disorders, the formation and circulation in the blood of radiotoxic substances that enhance the biological effect of penetrating radiation; 3) disintegration of the neuroendocrine system, violation of regulatory influences on internal organs; 4) disorders of the functions of the vascular system and the development of bleeding; 5) violations of hematopoiesis and immunogenesis, lowering resistance to infection.

The morphological substrate of acute radiation sickness is: a) dystrophic changes in organs and tissues; b) devastation of the bone marrow; c) signs of hemorrhagic syndrome; d) infectious complications.

In the clinical course ARS (mainly of the bone marrow form) is distinguished by four periods: the period of the primary reaction, or initial; hidden or latent; period of peak, or pronounced clinical manifestations; recovery period.

Primary reaction period It is characterized mainly by neuroregulatory disorders (dyspeptic syndrome), redistributive changes in the composition of the blood (transient neutrophilic leukocytosis), disorders of the analyzer systems. The direct damaging effect of penetrating radiation on the lymphoid tissue and bone marrow reveals itself as lymphopenia, the death of young cellular elements, and the presence of chromosomal aberrations in cells of the lymphoid and myeloid types. Typical clinical symptoms of this period, based on the severity of ARS, are presented in Table 2.

hidden period differs in external well-being, subsidence of vasovegetative disorders with a gradual increase in pathological disorders with a gradual increase in pathological changes in the most affected organs (lymphatic apparatus, bone marrow, germinal and intestinal epithelium). The severity of these changes is proportional to the absorbed radiation dose (Table 3).

peak period begins with a deterioration in well-being. Appetite disappears, headaches, nausea and vomiting reappear; general weakness, weakness, body temperature rises. Tachycardia, expansion of the boundaries of the heart, deafness of heart tones, hypotension are noted. On the ECG, a decrease in the voltage of the teeth, extrasystoles, a decrease in the S-T segment, a perversion of the T wave are found. Bronchitis and pneumonia, glossitis, ulcerative necrotic stomatitis, and gastroenterocolitis are often detected. Hemorrhagic diathesis develops. Severe neurological deficits may be seen. Changes in blood and hematopoiesis are progressing (Table 4). In a bacteriological study, a variety of flora (E. coli, staphylococcus, Proteus, yeast fungi, etc.) can be sown from the blood of patients. Signs of general intoxication are growing.

Recovery period manifested by an improvement in well-being, normalization of body temperature, resumption of appetite, disappearance of signs of hemorrhagic diathesis. Restoration of impaired functions and bone marrow hematopoiesis is often delayed for a long time. Asthenia, lability of blood pressure and hematological parameters (short-term leukocytosis, thrombocytosis), some trophic and metabolic disorders remain for a long time.

CLINIC OF ACUTE RADIATION SICKNESS - concept and types. Classification and features of the category "CLINIC OF ACUTE RADIATION SICKNESS" 2017, 2018.

Ticket 16.

Acute radiation sickness of mild (I) and moderate (II) severity. Clinic, diagnostics, treatment at the stages of medical evacuation.

Acute radiation sickness develops as a result of the death of dividing cells under the influence of short-term radiation at a dose of more than 1 Gy (100 rad). The development of the disease is possible in the conditions of an accident at a nuclear power plant and after total irradiation of the body for therapeutic purposes. There is a strict dependence of its manifestations on the absorbed dose of ionizing radiation. Beam energy leads to damage to cellular structures, which causes the development of mainly hematological syndrome.

Clinic for various forms of radiation sickness

In the case of a single irradiation at a dose of 0.25 Gy, no noticeable deviations are found in a routine clinical study.

When irradiated at a dose of 0.25-0.75 Gy, subtle changes in the blood picture, neurovascular regulation, occurring on the 5th-8th week from the moment of irradiation, can be noted.

Irradiation at a dose of 1-10 Gy causes typical forms of ARS with a leading hematopoietic disorder in its pathogenesis.

Irradiation at a dose of 10-20 Gy leads to the development of an intestinal form with a fatal outcome on the 10-14th day.

When a person is irradiated at a dose of 20-80 Gy, death occurs on the 5-7th day with increasing azotemia (toxemic form).

Direct early damage to the nervous system develops when irradiated at a dose of more than 80 Gy. Death in the nervous (acute) form is possible in the first hours or days after exposure.

During the bone marrow form, 4 periods are distinguished:

I - period of primary general reaction;

II - the period of apparent clinical well-being (latent);

III - the period of pronounced clinical manifestations (height of the disease);

IV - recovery period.

The division of the disease into these periods is relative, it is true for very uniform exposure.

According to the absorbed doses, acute radiation sickness is usually divided into 4 degrees of severity:

1) light (1-2 Gy);

2) medium (2-4 Gy);

3) heavy (4-6 Gy);

4) extremely severe (more than 6 Gy).

The clinical picture of the primary reaction depends on the radiation dose. With a mild degree of the disease, some affected people do not show any signs of a primary reaction at all. But in the majority, mild nausea appears 2-3 hours after irradiation, in some, a single vomiting is possible after 3-5 hours. In the next day, patients feel rapid fatigue during physical exertion.

The leading symptom of the primary reaction with moderate severity is vomiting. It occurs 1.5-3 hours after irradiation: the higher the dose and the more the upper half of the abdomen and chest is irradiated, the earlier vomiting will occur, the longer it will be. Along with vomiting, patients note the appearance of general weakness, and at doses of about 4 Gy, moderate reddening of the face and slight injection of the sclera are observed. During the day, the phenomena of the primary reaction subside: after 5-6 hours, vomiting stops, weakness gradually disappears. Moderate headache, fatigue persists. Slight hyperemia of the face disappears in 2-3 days. A certain place in the characteristics of the primary reaction is occupied by a change in the number of leukocytes in the peripheral blood. In the first hours after irradiation, there is an increase in the number of leukocytes, mainly due to neutrophils. This initial leukocytosis, lasting less than a day, does not show a clear relationship with the dose of exposure, although it can be noted that high leukocytosis is observed more often in more severe cases. An increase in the number of leukocytes of a redistributive nature is due to the release of granulocytic reserve from the bone marrow, while the height and duration of leukocytosis do not have a clear dependence on the intensity of irradiation. In this regard, primary leukocytosis is not a reliable indicator of the severity of radiation injury.

The period of external well-being is determined by the dose of radiation exposure and can last from 10-15 days to 4-5 weeks.

In many patients with mild severity of the disease at a dose of less than 1.5 Gy, there is no clear clinical picture of the primary reaction, and therefore, in these cases it is difficult to speak of a latent period.

With moderate severity, after the end of the primary reaction, the deviations in the state of health of patients are insignificant: it is difficult for them to engage in physical labor, it is difficult to concentrate on intellectual work, they quickly get tired, although they give the impression of healthy people. At the same time, distinct changes are found in the hematological picture: the number of leukocytes and platelets in the peripheral blood fluctuates. By the 7-9th day, the number of leukocytes decreases to 2000-3000 per 1 μl, then there is a temporary increase or stabilization of the indicators, lasting up to 20-32 days, then agranulocytosis occurs, which mainly determines the clinical signs of the height of the disease. Similarly, the number of platelets and reticulocytes also changes.

In the latent period of the hematological syndrome, epilation develops, as well as damage to the skin and mucous membranes.

The peak period should be determined primarily by the primary signs of the disease - a decrease in the number of leukocytes and platelets in the peripheral blood. Due to the very high radiosensitivity, lymphocytes decrease already in the first days after exposure, but lymphopenia does not noticeably affect the clinical picture of the disease.

With uniform irradiation in medium doses, the peak of the disease is characterized exclusively by leuko- and thrombocytopenia and associated complications of an infectious nature, bleeding.

A mild degree at a dose of 1-1.5 Gy is usually not accompanied by agranulocytosis, and therefore there are no infectious complications. The peak period can only be noted by a decrease in leukocytes to 1500-2000 per 1 μl, which occurs at the beginning or middle of the second month of illness. Until this period, the abortive rise in the number of leukocytes continues. When the radiation dose approaches 2 Gy, agranulocytosis develops on the 32nd day of illness, and the clinical picture of the disease corresponds to the moderate severity of the lesion. The duration of agranulocytosis does not exceed 7-8 days, but it can be very deep (up to 200-500 cells per 1 µl in the complete absence of granulocytes), which causes severe infectious complications. The most common are follicular and lacunar tonsillitis, however, as with any myelotoxic agranulocytosis, the possibility of severe pneumonia, esophagitis, perforated intestinal ulcers, and the development of sepsis cannot be ruled out.

If the onset of the peak of the disease should be determined not by external manifestations, but by a drop in leukocytes below critical numbers, then the end of agranulocytosis is sometimes noted not so much by an increase in the number of leukocytes, but by an improvement in the patient's condition, by normalization of temperature. Essentially, activation of hematopoiesis occurs earlier, but with a slight increase in granulocytes in the blood, almost all of them are absorbed by the infectious focus.

The picture of the bone marrow in the peak period corresponds to complete aplasia: in the trepanate, the disappearance of foci of hematopoiesis is noted, there are almost no hematopoietic cells. A few days before the cessation of agranulocytosis, before the appearance of granulocytes in the peripheral blood, there are already clear signs of proliferation of hematopoietic cells in the bone marrow.

When exposed to a dose of more than 3 Gy on the intestinal area, radiation enteritis develops. When irradiated up to 5 Gy, it manifests itself as a slight bloating on the 3-4th week after irradiation, unfrequented mushy stools, and an increase in temperature to febrile numbers. The time of appearance of these signs is determined by the dose: the larger it is, the earlier the intestinal syndrome appears. At high doses, severe enteritis develops: diarrhea, flatulence, abdominal pain, bloating, splashing and rumbling, pain in the ileocecal region. Intestinal syndrome may be accompanied by damage to the colon, in particular the rectum, with the appearance of characteristic tenesmus, radiation gastritis, radiation esophagitis. Radiation gastritis and esophagitis develop at the beginning of the second month of the disease, when the bone marrow lesion is already behind.

Even later, after 3-4 months, radiation hepatitis begins. Its peculiarity is that jaundice occurs without a prodrome, bilirubinemia is low, but the level of transaminases is very high (from 200 to 250 units), skin itching is pronounced. For several months, the process goes through many "waves" and gradually subsides. "Waves" consist in increased itching, some rise in bilirubin and pronounced hypertransaminasemia. The prognosis for hepatic lesions appears to be good, although specific therapeutic agents have not yet been found (prednisolone clearly worsens the course of radiation hepatitis).

The skin of the armpits, inguinal folds, elbows, and neck is the most radiosensitive. Radiation dermatitis goes through the phases of primary erythema, edema, secondary erythema, development of blisters and ulcers, epithelialization. The prognosis of skin lesions also depends on the damage to the vessels of the skin of large arterial trunks. Vessels undergo progressive sclerotic changes over many years, and previously healed skin radiation ulcers can cause re-necrosis after a long time. Outside of vascular lesions, secondary erythema ends with pigmentation at the site of a radiation burn, often with thickening of the subcutaneous tissue. In this place, the skin is usually atrophic, vulnerable, prone to the formation of secondary ulcers. At the site of the blisters, nodular skin scars are formed with multiple angioectasias on atrophic skin.

The recovery period begins at the end of the 2-3rd month, when the general condition of patients gradually improves. But even with the normalization of blood counts, the disappearance of intestinal disorders, severe asthenia remains. Full recovery in patients can occur over many months, and sometimes years. The composition of the blood normalizes with a mild degree by the end of the second month, with an average degree - by its middle, and with a severe degree - by the end of the first, the beginning of the second month after irradiation. Restoration of the ability to self-service occurs after the elimination of agranulocytosis, oral and intestinal lesions. With a mild degree, patients do not lose the ability to self-service. With moderate severity, in deciding whether to discharge a patient from a hospital, one cannot focus only on the restoration of hematopoiesis. Severe asthenia makes these people unable to work for about six months. Usually, with a severe degree of the disease, they are discharged from the hospital 4-6 months after the onset of the disease, and sometimes later, if the general manifestations of radiation sickness are accompanied by local lesions.

Diagnostics

With a characteristic picture of the primary reaction, knowledge of its temporal characteristics, as well as quantitative and temporal parameters of changes in the levels of lymphocytes, leukocytes, platelets, the diagnosis of ARS does not present great difficulties, including its severity.

At present, for the diagnosis of radiation injury, a method of chromosomal analysis of peripheral blood lymphocytes stimulated by phytohemagglutinins has been proposed. Chromosomal analysis detects overexposure long after exposure but does not provide reliable information on local doses. Preservation in the bone marrow of cells with damaged chromosomes capable of mitosis under the influence of phytohemagglutinin many years after irradiation of this area of the bone marrow significantly refines biological dosimetry in the long term after irradiation. practically equal to 100. Determination of higher doses is possible only in a single cell: the higher the dose, the more the cell is saturated with broken chromosomes.

Treatment

To prevent vomiting, patients are prescribed Cerucal 1 tablet 5 times a day, the drug can be administered intravenously, 2 ml every 2 hours 4-6 times a day. If the administration of cerucal does not prevent vomiting, injections of droperidol 0.25% -1.0 ml or haloperidol 0.5-1.0 ml of a 0.5% solution intramuscularly or subcutaneous injection 0.5-1 0 ml of a 0.1% solution of atropine.

Classification of pesticides.

Main groups: