Radiation sickness treatment. radiation sickness in humans

Ionizing radiation, even in moderate portions, but with a systematic effect on the human body, is harmful, hazardous to health. The consequences of exposure to radiation are fatal, not always compatible with life. If effective treatment is started in a timely manner, the patient can still be saved and cured.

What is radiation sickness

If the doses of radiation received exceed the allowable limits, the risk of developing a disease increases markedly, which, in official medicine called "radiation disease". Radioactive exposure provokes systemic damage to the nervous, hematopoietic, cardiovascular, digestive, endocrine systems, hematopoietic organs and the dermis.

Against the background of prolonged exposure to ionizing radiation on the skin, part of the tissues dies off, since a capacious concentration of harmful substances accumulates in their structure. In addition, radiation penetrates the body and has a detrimental effect on internal organs. To avoid a fatal clinical outcome, timely therapy under the guidance of a specialist is indicated.

Reasons for the appearance

Radioactive substances and various types of radiation dominate in the air, water, soil, and food. Such disease-provoking factors enter the body through the skin, mucous membranes, with food and through drug therapy. The development of a characteristic ailment depends on the dose of radiation received by a particular patient. Doctors identify the following causes of radiation sickness:

impact on the body of radiation waves;
penetration into the organic resource of reactive compounds;
systematic impact on the body of x-ray exposure.

Degrees

The disease proceeds in acute and chronic form, which determines the features of the clinical picture. In the first case, the symptoms of radiation exposure in humans are intense, which makes it easier differential diagnosis. In the second case, the clinic is moderate, and put final diagnosis sometimes problematic. Below are the main stages of radiation sickness, which further determine the course effective treatment:

First (light) degree. 100-200 rad. The patient is worried about nausea, single vomiting.
Second (middle) degree. 200-400 rad. The patient is characterized by prolonged vomiting.
Third (severe) degree. 400-600 rad. Vomiting is characterized by a duration of up to 12 hours.
Fourth (extremely severe) degree. More than 600 rad. Prolonged vomiting that occurs after 30 minutes.

Forms

If there are characteristic symptoms the harmful effects of radiation, the attending physician determines not only the stage, but also the form of radiation sickness. The pathological process is represented by such varieties of the specified diagnosis:

Radiation injury. Simultaneous exposure to a dose of radiation less than 1 gram may cause slight nausea.
Bone form. It is considered typical, diagnosed when exposed to radiation 1-6 gr. at the same time.
Gastrointestinal form. Irradiation with a dose of 10-20 g takes place, which is accompanied by intestinal disorders, proceeds with severe enteritis and bleeding from the gastrointestinal tract.
vascular form. It is considered toxemic, it provides for the impact on the body of irradiation with a dose of 20-80 gr. It proceeds with fever, with infectious and septic complications.
cerebral form. Radiation with a dose of 80 gr. Death occurs on 1-3 days from the moment of irradiation from cerebral edema. There are four phases: the primary general reactivity phase, the latent phase, the extended symptoms phase, and the recovery phase.

Radiation sickness - symptoms

Symptoms of the disease depend on the dose of radiation to which the human body was exposed. General symptoms radiation sickness are presented below, negatively affect the general well-being, are similar to the manifestations of food intoxication. The patient complains about:

nausea;
frequent bouts of vomiting;
dizziness;
migraine attacks;
dryness, bitterness in the mouth;
increase in body temperature;
cyanosis of the skin;
drop in blood pressure;
cramps of the limbs;
signs of dyspepsia (stool disorder);
general weakness.

First signs

The disease progresses in the acute phase, which is characterized by a sharp deterioration general well-being, decline in performance. The first signs of radiation sickness include massive death of bone marrow cells, which must divide for the normal functionality of the body. As a result, hemodynamic disturbances occur, there is a tendency to infectious complications, skin lesions, and problems from the gastrointestinal tract. The initial signs of exposure begin to develop with nausea, dizziness and headache, supplemented by bitterness in the mouth.

Radiation sickness treatment

Intensive care begins with bed rest and aseptic living conditions. Conservative treatment of radiation sickness includes gastric lavage to alleviate the severity of the pathological process, PHO ran, forced diuresis, prevention of collapse, administration of antiemetics, maintenance of the body's water balance. Short Course antibiotics are needed to prevent infectious complications. The affected person is supposed to receive parenteral nutrition, treatment of mucous membranes with antiseptics.

First aid

The actions of the doctor are coordinated, fast. The disease leads to irreversible consequences for health, so it is important to suppress the signs of the acute phase in a timely manner. First help with radiation sickness provides for resuscitation which include:

Evacuation of the injured party, termination of the effect of radioactive exposure on the body.
Washing the affected mucous membranes with a 2% solution of sodium bicarbonate, cleansing the stomach through a tube.
Treatment open wound distilled water, while observing the rules of asepsis.
Intramuscular administration 6-10 ml of 5% Unitiol solution for rapid removal of radioactive substances from the body.
Intravenous administration of antihistamines, ascorbic acid, calcium chloride, hypertonic glucose solution.

Consequences

If the disease is chronic, symptomatic treatment. Absence intensive care leads to fatal consequences of radiation sickness, which for the patient can even end in death. Radiation influence, in any case, is detrimental. It is important to know what to fear, so the list potential complications detailed below:

oncology;
changes in the reproductive system;
genetic effects (during irradiation of a pregnant woman);
immune diseases;
radiation cataract;
rapid sclerotic processes;
reduction in life expectancy;
Albright syndrome;
radiocarcinogenesis;
teratogenic effects;
the severity of chronic diseases of the body;
somatic and stochastic effects;
violations of the hematopoietic system.

Mutations

The consequences of radiation are irreversible, and can manifest themselves through a generation and more than one. Mutations from radiation sickness are not fully understood by physicians, but the fact of their existence has been established. A relatively new science, genetics, deals with this area of disease. Genetic changes have the following classification, determine the nature of the pathological process. It:

chromosomal aberrations and changes in the genes themselves;
dominant and recessive.

Prevention

To prevent ARS and CRS, it is important to take care of preventive measures activities, especially for patients at risk. Medical preparations prescribed by a doctor, it is important not to violate their dosage. Prevention of radiation sickness involves the reception of representatives of the following pharmacological groups:

vitamins of group B;
hormonal anabolics;
immunostimulants.

Video

Each disease is dangerous and insidious in its own way. Unpleasant symptoms, along with poor health, make us think that the disease has already begun. Such a phenomenon as radiation sickness is a prominent representative of such ailments. Many have heard about the existence of radiation pathologies and the seriousness of such consequences for humans. The event in Chernobyl, known throughout the world, to the maximum a short time conveyed to people information about the presence of a serious danger that comes from radioactive radiation. What exactly lies in this kind of danger, we will find out in this article. How to recognize the signs of radiation sickness?

How does illness occur?

So, radiation sickness is a reaction on the part of the human body to the effects of life-threatening radioactive radiation. Under the influence of such unfavorable factor unnatural for normal functioning processes that entail certain failures in many structures of life. This disease is extremely life-threatening, as it is an irreversible process, pernicious influence which can only be interrupted a little. Signs of radiation sickness are important to identify in a timely manner.

Influence of radioactive radiation

Radioactive radiation affects the body as an aggressive factor that causes its danger directly depends on the time and total area of radiation. In addition, the way radiation enters the body also affects. An equally important role is played by the immune resistance of the human body.

Given the degree of damage, the basic zones are distinguished, most often undergoing pathological changes as a result of radiation sickness:

Digestive system.
Nervous system.
Spinal cord.
Circulatory system.

The consequences of radiation pathology in these parts of the body lead to serious dysfunctions that occur as a single complication or may be combined with several. A similar combination is observed with lesions of the third degree. Such consequences can acquire very serious forms up to death.

Classification of radiation sickness

Depending on the period of exposure to radiation on the body, radiation sickness is divided into the following types:

Sharp shape.
chronic form.

Acute radiation sickness is considered a consequence of a short exposure to radiation, which is more than 1 gram. Such a dose is a critical form that causes rapid changes in the human body, which mainly lead to serious complications, and sometimes to the death of the patient.

Signs of radiation sickness vary in degree.

Chronic form

Chronic radiation pathology may occur as a result of prolonged contact with a radiation source, the radiation from which is equal to the limit of up to 1 g. Often, patients with chronic radiation sickness are workers at nuclear power plants who have to come into contact with radiation. Depending on the degree of penetration of radiation, this disease is classified into the following types:

An internal form that occurs as a consequence of the ingestion of radioactive elements. In this case, radiation enters through the respiratory or digestive system. This factor is decisive in the treatment, since it is precisely those organs through which the irradiation has passed that are affected first of all.
The external form in which radioactive exposure occurs through the skin of a person.

Thus, radiation sickness, the signs of which have already made themselves felt, can have different forms, it is classified depending on the severity of the disease.

Radiation sickness: the degree of damage to the body

All possible, as a rule, lead to serious dysfunctions that can manifest themselves in the form of single complications or be combined with several at once. In total, there are three degrees of radiation exposure:

First degree. This stage of the lesion differs minimally dangerous influence radiation per person. Symptoms of the disease at this stage are not even always manifested. At the same time, full diagnostics shows only initial pathological changes in the functioning of vital systems. This stage is successfully corrected through timely medical treatment. What are the signs of radiation sickness after radiation therapy?
Second degree. This degree of the disease has more pronounced manifestations compared to the previous form. The consequences of such radioactive exposure can also be quite successfully treated. But against its background, the risk of serious health problems in the future increases several times. Unfortunately, quite often these problems become cancerous diseases.
Third degree. This form is a serious threat to human life. It is characterized by numerous changes in the normal functioning of the vital systems of the body, which can often lead to his death. Treatment of such conditions is mainly aimed at eliminating the consequences of radioactive exposure. It should be noted that the consequences of third-degree radiation exposure are almost irreversible. A person can only partially improve his health, but, unfortunately, cases of complete disability are not uncommon.

Signs of radiation sickness

Radiation sickness, the treatment of which has not yet begun, has its own symptoms, which manifest themselves depending on the degree of damage to the body by radiation. So, what is the first sign of radiation sickness? More on this later.

The main symptoms are:

Against the background of the first degree of the disease, a person develops a feeling of nausea, vomiting, dryness or bitterness in the mouth. The development of tachycardia and tremor is not excluded. All these symptoms are temporary and soon, as a rule, disappear after rehabilitation therapy, as well as the elimination of the source of radiation. We can say that this is the first sign of radiation sickness.
As part of the radiation damage of the second degree, a violation in the coordination of movements is often noted along with the presence of skin rashes over the entire body area. Also, a person may begin to experience periodic spasms of the eyes, and, in addition, all symptoms of the first degree appear. In the event that the required therapy is not carried out in a timely manner, the second degree may develop into the next more severe form. Patients may also develop baldness. The condition may be accompanied by a decrease in reflex reactions. At this stage, the patient's blood pressure drops. Signs of radiation sickness differ markedly in degrees.
Symptoms of the third degree of exposure mainly depend on which organs were affected due to radioactive interference. AT similar states the patient has all the above symptoms, and in addition, those that are characteristic of concomitant pathology. At this phase of the disease, the state of immunity deteriorates noticeably in patients, and, in addition, hemorrhagic syndrome occurs, which is accompanied by heavy bleeding. At this stage, complete intoxication of the body occurs. There is an exacerbation of the risk of various infectious diseases.

The fourth degree - against the background of all this, the patient's temperature rises and blood pressure drops. There are signs of acute radiation sickness. Also, in patients, the pulse quickens and the person begins to overcome weakness. It is not excluded the occurrence of edema in the gum area along with the appearance of necrotic ulcers in the digestive system.

These are the main signs of radiation sickness of 1-4 degrees.

Diagnosis of radiation sickness

Diagnosis of radiation pathology is carried out through various medical appointments and methods, which directly depends on the stage at which this dangerous disease occurs. First of all, in such cases it is necessary to collect a detailed anamnesis. The doctor listens to all complaints of the patient. After that, the following blood tests are mandatory:

General clinical analysis.
Blood for biochemistry.
Coagulogram.

In addition, in the diagnosis, a study of the patient's bone marrow along with his internal organs is carried out. Such diagnosis is carried out by means of ultrasound examination. In addition, endoscopy and radiography are performed. It is thanks to the blood count that it is possible to determine the severity of the disease. Later, according to a blood test, one can also observe the dynamism of the phase changes of the disease.

Preventive measures

It is important to determine the signs of radiation sickness of the 1st degree in time. But ideally, it is better not to allow the development of the disease at all.

In order to prevent radiation sickness, constant use is required. various options protection in the event that a person is directly in the zone of radio emission. Also, as part of preventive measures, drugs that are radioprotectors are used, which can significantly reduce the radiosensitivity of the human body. In addition, radioprotectors slow down the course of various radiochemical reactions. It should be noted that the use of such drugs occurs half an hour before contact with radiation. The immediate protective properties of such drugs act for five hours.

And it is important to remember that the signs of death from acute radiation sickness are indomitable vomiting, bloody diarrhea, unconsciousness, general convulsions, then death.

Radiation sickness treatment

Unfortunately, no one is immune from radiation sickness. This disease is diagnosed in medical practice not only in adults, but also in young children. The reasons for its occurrence are always very different, ranging from ordinary food taken from the Chernobyl zone, ending with radiation exposure in industrial conditions. Timely diagnosis of the disease often saves the lives of many people, and, on the contrary, delaying treatment often ends lethal outcome. As a rule, the main methods of treatment of radiation pathology are directed to the following methods:

Determined full picture defeat internal organs. It is on the basis of such an examination that complex therapy is prescribed, which is aimed at restoring, for example, the organs of the digestive, hematopoietic or nervous system. Much, as already noted, depends on when radiation sickness was recorded, its signs and periods.

Alternative methods of treatment of radiation pathology

Folk remedies for the treatment of radiation pathologies are often used as part of a comprehensive treatment of the disease, along with the main drug therapy. In fact, there are a lot of ways to treat radiation sickness, but listing all modern techniques and methods, and, in addition, to name specific drugs is inappropriate due to the fact that prescribing rehabilitation treatment in should only the attending physician.

So, as already noted, folk remedies to eliminate the signs of acute radiation sickness are often used as part of complex treatment along with the main drug therapy. Non-traditional therapy is aimed at removing radionuclides from the body, in addition, the immune system is stimulated. For all these purposes, the traditional field of medicine has a whole arsenal of excellent tools that can have a mild effect on the entire body, allowing you to use similar methods for a long time. Alternative treatment is quite effective and is considered an excellent way for prevention.

The most proven means

In fact, there are a lot of all kinds of recipes, consider some of the most proven and effective ones:

Tincture prepared on the basis of needles. With the help of this tincture, it is possible to neutralize the radioactive influence, that is, to remove radionuclides from the human body. Such an infusion is prepared on the basis of half a liter of boiled water. Five tablespoons of frayed pine needles are also taken. It is not necessary to bring the tincture to a boil. It is required to insist within one day. The prepared medicine is required to be drunk during the day in full. The procedure is repeated a day later for one month.
Sea buckthorn oil. Healing oil from sea buckthorn is perfect not only for preventive measures, but also for treatment. This product has a pronounced anti-radiation effect. The essence of the application is as follows: take one teaspoon sea buckthorn oil three times a day for exactly one month.

The article deals with radiation sickness, signs, symptoms, consequences are presented.

Radiation sickness is a pathological condition of a person, which is caused by systematic exposure of the body to radioactive irradiation. The clinical picture appears if the radiation dose exceeds 100 rad (1 Gy). If the dose is less than indicated, then we can talk about the asymptomatic course of radiation sickness.

Etiology

Etiological factors that can provoke the development of radiation sickness are the following:

short, but intense impact on the body of radiation waves;
systematic exposure of a person to X-ray waves;
ingestion of radioactive compounds.

Irradiation is possible even in the case of a slight contact with the skin of radioactive rays. In this case, signs of the disease appear on the affected area of \u200b\u200bthe skin. If at this stage the necessary medical care is not provided and treatment is not started, the disease can give serious complications.

Pathogenesis

The pathogenesis of radiation sickness is quite simple. Radiation that penetrates human tissues is the cause of the formation of an oxidative reaction. Against the background of this process, the antioxidant defense system is significantly weakened and cannot fully perform its functions. As a result, the affected cells die. Such a mechanism for the development of the disease leads to disruption of the normal functioning of such systems:

central nervous system;
cardiovascular;
endocrine;
hematopoietic.

How large dose radiation received by a person, the faster the clinical picture will develop. In addition, it is worth noting that if a person is at this time near the explosion or at its epicenter, the body will be additionally affected:

exposure to mechanical and light energy;
heat.

Therefore, in addition to violations in the functioning of systems, chemical burns are possible.

The degree of development of the disease and forms

There are two forms of radiation sickness - chronic and acute. Chronic radiation sickness may show no signs at all until a certain moment. Acute radiation sickness has a well-defined clinical picture.

In modern medicine, there are four degrees of radiation sickness:

mild (irradiation up to 2 Gy);
medium (from 2 to 4 Gy);
heavy (from 4 to 6 Gy);
very heavy (more than 6 Gy).

The last two stages of the disease have already irreversible processes. Not an exception - a lethal outcome.

General symptoms

Chronic radiation sickness is asymptomatic in the initial stages. The clinical picture appears somewhat later.

Acute radiation sickness manifests itself in the form of such symptoms:

severe headache, sometimes accompanied by dizziness;
nausea and vomiting;
nose bleed;
general malaise, weakness;
seen on blood test increased content and ;
in some places the skin turns red and begins to itch.

The period of manifestation of such symptoms lasts no more than one week. As the disease develops, the clinical picture is supplemented by the following symptoms:

low body temperature;
Strong headache;
cramps in the lower extremities;
loss of appetite, nausea;
unstable blood pressure.

With the last degree of development of acute radiation sickness, the general condition of the patient worsens significantly, the clinical picture is supplemented by the following symptoms:

hair loss, thinning of the skin and nail plates;
disruption at work genitourinary system(women have irregular menstruation, men have problems with potency);
the formation of ulcers on the mucous membranes of the mouth, intestines and stomach;
fever, for no apparent reason;
severely weakened immunity.

The last period of development of the acute form of the disease begins approximately 4 weeks after exposure. Restoring the functionality of the systems is possible if the correct treatment is started. The most difficult thing is to restore the functioning of the genitourinary system.

It is noteworthy that in the second stage of the development of acute radiation sickness, the symptoms may partially disappear, the patient's condition may improve significantly. But this does not say anything about the recovery of a person.

After radiation sickness, the likelihood of developing complications is high. Most often this is associated with the work of the digestive tract, of cardio-vascular system.

Classification of the disease

In modern medicine, types of radiation sickness are distinguished according to the time and nature of localization.

According to the time of irradiation, the following forms are distinguished:

single;
prolonged;
chronic.

According to the nature of localization:

local or general form;
uniform or uneven.

As shows medical practice, the acute stage of the development of the disease is accompanied by lesions in all areas of the skin and at all levels - tissue, molecular, organ. Almost always there is swelling of the brain. If the patient is not given the correct treatment, then a lethal outcome is not ruled out.

Diagnostics

If you have the above symptoms, you should immediately contact an oncologist or therapist. After a personal examination and clarification of symptoms, a general history, laboratory and instrumental methods of research are carried out.

The laboratory research program includes the following:

blood clotting testing.

Concerning instrumental methods studies, the standard program includes such analyzes:

puncture biopsy of the bone marrow;
electroencephalography.

Only on the basis of all the tests passed, it is possible to accurately diagnose, identify the degree of development of the disease and prescribe the correct course of treatment.

It should be noted that the diagnostic program can be supplemented by other research methods. It all depends on the degree of development of radiation sickness and what systems of the human body are involved in the pathological process.

Treatment

Radiation sickness of a person at an early stage is treated quite well. But it should be understood that such an effect of radiation on the human body does not pass without a trace. After completing the course of treatment, the patient needs a long period of rehabilitation.

Drug treatment involves taking such drugs:

antihistamines;
antibiotics;
for general strengthening of the immune system;
vitamin complexes.

If the patient is diagnosed with the third stage of the disease, then in addition to the above drugs, antihemorrhagic agents are prescribed. Blood transfusion is also mandatory.

In addition, at any stage of the development of the disease, physiotherapy procedures are used - oxygen masks and exercise therapy. It is worth noting that during this period it is very important for the patient to eat right. Proper treatment of radiation sickness gives positive results and significantly reduces the risk of serious diseases.

Nutrition for radiation sickness

During the period of treatment and medication, the patient should eat right:

consume the optimal amount of liquid - at least 2 liters per day (including juices and tea);
do not drink while eating;
steamed food is preferred;
the consumption of fatty, spicy, salty foods is minimized.

You need to eat in small portions, but quite often - at least 5 times a day. Smoking and alcohol consumption are naturally excluded.

Possible Complications

Depending on the nature of the development of the disease and the general health of the patient, radiation sickness can cause complications. The most common side effects of radiation sickness are:

ophthalmic diseases;
malignant tumors that can cause severe cancer;
complete baldness of the human skin;
disorders in hematopoiesis.

Such complications can be avoided at least partially if the disease is diagnosed at an early stage and the correct treatment is started. Therefore, at the first symptoms, you should immediately seek medical help.

Prevention

Prevention of radiation sickness is especially important for those people who live in the area increased radiation. But such events are also important for residents of other countries.

For people who are at risk, prevention is as follows:

taking vitamins of group B6, P, C;
hormonal anabolic drugs;
drugs to strengthen the immune system.

But you need to consume such drugs strictly according to the doctor's prescription.

General prevention includes taking radioprotectors, vitamins and general strengthening of immunity. Such measures minimize the risk of developing a pathological process. If a person has the above signs of illness, you should immediately seek medical help. Procrastination or self-medication can not only accelerate the development of the disease, but also cause the development of serious complications.

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RADIATION SICKNESS- a disease that develops as a result of the action of ionizing radiation in doses exceeding the permissible ones. Depending on character of influence (single massive or long repeated in rather small doses) distinguish sharp and hron, respectively, L.'s forms. varying degrees of severity with a predominance of local or general changes.

Changes in the function of the nervous, endocrine systems and dysregulation of the activity of other body systems, together with cellular and tissue lesions, form a wedge, manifestations of L. b.

The damaging effect of ionizing radiation especially affects the stem cells of the hematopoietic tissue, the epithelium of the testicles, the small intestine and the end; it depends on the level and distribution of the radiation dose in time and volume of the body. First of all, systems that are in a state of active organogenesis and differentiation during irradiation are affected (see Critical Organ). At radiation, especially in small doses, individual reactivity and funkts, a condition of nervous and endocrine systems matters.

Acute radiation sickness

pathological anatomy

Most of the publications are descriptions of the pathoanatomical picture of acute L. b. in various experimental animals, and only a few of them concern people who died in the explosion of the atomic bomb in Japan and in accidents. The most fully studied pathological anatomy of the so-called. bone marrow form of acute L. b. with a primary lesion of the hematopoietic tissue (see Hematopoiesis), which develops when exposed to ionizing radiation in doses up to 1000 rad. Acute L. characteristic of this form. morfol, changes are shown in the latent period and become expressed in the peak of a disease. At the same time, signs of hemorrhagic diathesis are macroscopically detected: hemorrhages in the skin, serous and mucous membranes, in parenchymal organs. The severity of hemorrhagic diathesis varies widely depending on the severity of the lesion; additional injuries increase the phenomena of bleeding. Abundant hemorrhages in the stomach and intestines, in the lungs, in the adrenal glands with their destruction, extensive hemorrhages in the myocardium, capturing the conduction system of the heart, can be decisive in the outcome of the disease (tsvetn. Fig. 2-4). The active bone marrow loses its usual consistency and becomes liquid, its color is determined by the admixture of blood; limf, nodes look enlarged due to hemorrhagic impregnation of the tissue. Deep disorders in the hematopoietic system determine the tendency to bleeding and the frequency of development of inf. complications, which, as a rule, are detected during the height of the disease. These include ulcerative necrotic gingivitis, necrotic tonsillitis (printing. Fig. 1), pneumonia, inflammatory changes in the small and large intestines. In other organs, signs of circulatory disorders and dystrophic changes are found. Skin lesions (hair loss, radiation burns) can be clearly manifested with significant exposure; in victims of an atomic explosion, they were combined, as a rule, with thermal burns.

At microscopic examination changes of bodies of a hemopoiesis are most characteristic, initial signs of defeat of which are found in the latent period long before bright a wedge, manifestations of acute L. b. In limf, nodes in the first hours after irradiation, one can see the disintegration of lymphocytes, especially in the central part of the follicles, i.e., in the area where B-lymphocytes are located; somewhat later, changes in the paracortical layer (zone of T-lymphocytes) are detected. During the height of the disease, against the background of severe hyperemia, the elements of the stroma of the lymph nodes, the node and plasma cells are mainly distinguishable. Similar changes are observed in almonds, a spleen, group follicles (Peyer's patches) and solitary follicles went. - kish. tract. Aplasia develops rapidly in the bone marrow: by the third day, according to some authors, only approx. ten% cellular composition, which is explained by the increased release of mature forms into the peripheral channel, the cessation of division and cell decay (interphase death); subsequently, mitotic activity resumes for a certain time, but the dividing cells die in the process of mitosis. Rapid and significant cellular devastation is accompanied, as it were, by a vicarious plethora of bone marrow vessels with ruptures of the vascular walls and the formation of hemorrhage fields. In the peak period of acute L. b. in the bone marrow there is almost no ordinary hematopoietic tissue, mainly elements of the stroma and plasma cells are visible (Fig.). The defeat of lymphoid tissue and bone marrow leads to a decrease in immunobiol, reactivity of the body and creates favorable conditions for the development of various complications, ch. arr. autoinfectious.

During recovery, phenomena of regeneration of hematopoietic cells are found, but even after long time against the background of a decrease in the total number of bone marrow cells, as a rule, a delay in cell differentiation and maturation is detected; in gematol, preparations younger cellular elements prevail. Regeneration of the lymphoid tissue occurs later than the restoration of the bone marrow: in the lymph nodes, a cortical layer with a diffuse arrangement of cellular elements is formed, then follicles are formed, and later the restoration of the paracortical layer (T-lymphocyte zone) occurs.

At L. b. typical changes in the gonads develop, especially male. In the latent period, the cessation of mitotic division and the disintegration of the epithelium of the testicles, the appearance of individual ugly large and giant cells are found; during the height of the disease in the tubules of the testicles there is no germinal epithelium, only individual spermatogonia and Sertoli cells remain. In the ovaries, dystrophic and necrobiotic changes are observed, which initially occur in more mature follicles and consist in the death of the eggs, and a little later - the cells of the inner layer of the granular membrane.

The mucous membrane of the small intestine is highly sensitive to ionizing radiation, early changes a cut are shown by destruction and suppression of mitotic activity of cells of an epithelium of crypts with the advent patol, forms of a mitosis. By the time of development of the expressed wedge, signs of a disease these changes, as a rule, disappear. Terminal changes are associated with a disorder of blood and lymph circulation, autoinfectious processes: the mucous membrane is edematous, there are areas of ulceration and necrosis, on the surface of which molten masses of fibrin, mucus and colonies of microorganisms are visible; almost completely absent leukocyte infiltration, proliferation of local connective tissue and epithelial cells. Large digestive glands belong to the category of organs insensitive to ionizing radiation, however, microscopic examination, for example, in the liver, reveals circulatory disorders and signs of dystrophy, and by the time of death, significant destructive changes with signs of microbial and viral invasion (see Hepatitis, radiation) .

In the cardiovascular system in acute L. b. deep changes are localized by hl. arr. in small vessels, which is important in the pathogenesis of hemorrhagic diathesis. Morfol, signs of increasing vascular permeability in the form of edema of the wall, some swelling and detachment of the endothelium, increasing perivascular edema and rupture of the vascular walls are detected even before the occurrence of hemorrhages. During the height of L. b. visible diapedetic hemorrhages, diffuse impregnation of the walls of blood vessels with erythrocytes and the phenomenon of plasmorrhagia. In the heart, there are dystrophic changes in muscle fibers, hemorrhages under the endocardium, into the myocardium, and especially under the epicardium.

In the lungs with acute L. b. the changes connected with disturbance of blood circulation and inf are found. complications, among which special attention deserves the so-called. agranulocytic pneumonia, accompanied by the loss of serous-fibrinous-hemorrhagic exudate, the formation of foci of necrosis with colonies of microorganisms without a perifocal inflammatory reaction.

In the kidneys with acute L. b. are observed ch. arr. circulatory disorders and high vascular permeability: hemorrhages are visible in their tissue, a protein liquid with an admixture of erythrocytes accumulates in the lumens of the glomerular capsules, dystrophic changes in the epithelium of the convoluted tubules are noted.

For acute L. deep disturbance of activity of endocrine glands is characteristic, a cut is initially estimated as display of the strengthened function; in the future, relative normalization occurs, and in the period of the peak of the disease, signs of funkts, depletion of the glands are revealed. After radiation exposure in lethal doses, degranulation of chromophilic cells occurs in the pituitary gland; in thyroid gland the size of the follicles decreases, the follicular epithelium hypertrophies, vacuolization and resorption of the colloid are noted. In the adrenal cortex, a redistribution of fatty inclusions occurs, in the medulla, a decrease in the number and sometimes a complete exit from the cells of chromaffin inclusions is observed.

In loose connective tissue - dystrophic changes, cell breakdown, a sharp decrease in the number and shift in the ratio of cellular forms in favor of mature ones, destruction of fibers and interstitial substance. AT bone tissue- phenomena of bone resorption.

Changes in the nervous system in acute L. b. in the form of reactive phenomena or destruction develop in parallel with vascular disorders, are focal in nature and are localized in nerve cells, fibers and endings.

At radiation doses of 1000-2000 rad, radiation damage to the small intestine (intestinal form of acute L. b.) dominates: the mucous membrane is thinned, covered with a few, grossly altered epithelial cells, and the submucosa of the intestinal wall is exposed in places. These changes are due to the death and cessation of fiziol, renewal of the intestinal epithelium under conditions of continued desquamation of cells from the surface of the villi of the mucous membrane in accordance with the life cycle of the tissue. Similar changes in the intestinal wall can also develop with local irradiation of the abdomen or even individual loops of the intestine.

At an irradiation dose from 2000 to 5000 rad, especially with uneven exposure, pronounced hemodynamic disturbances predominate, Ch. arr. in the intestines and liver, with a sharp overflow of blood capillaries, venous vessels and the appearance of hemorrhages. The mucous membrane of the small intestine looks moderately swollen, micronecrosis and discomplexation of the parenchyma are noted in the liver.

So called. nervous form of acute L. b. develops when irradiated in doses of St. 5000 rad. At the same time, disorders of blood circulation and liquor circulation with the development of cerebral edema prevail in the brain.

Clinical picture

In a wedge, acute L.'s current. (ch. arr. bone marrow form) there are four periods: the initial, or the period of the primary general reaction; hidden, or latent, period of a visible wedge, well-being; the peak period, or the expressed wedge, manifestations; recovery period.

The period of the primary general reaction lasts from several hours to 1-2 days, is characterized by the predominance of neuro-regulatory shifts, Ch. arr. reflex (dyspeptic syndrome); redistributive shifts in the composition of the blood (more often neutrophilic leukocytosis); violations of the activity of analyzer systems. Symptoms of the direct damaging effect of ionizing radiation on lymphoid tissue and bone marrow are found: a decrease in the number of lymphocytes, the death of young cellular elements, the occurrence of chromosomal aberrations in bone marrow cells and lymphocytes. Characteristic wedge, symptoms in the initial period - nausea, vomiting, headache, fever, general weakness, erythema. During the period of the primary general reaction against the background of developing general weakness and vasovegetative shifts appear increased drowsiness, lethargy, alternating with a state of euphoric excitement. With acute L. b. severe and extremely severe, Meningeal and cerebral symptoms occur with increasing clouding of consciousness (from hypersomnia to stupor and coma), which during the recovery period may affect the structure of the emerging neuropsychiatric syndrome.

The latent period lasts, depending on the radiation dose, from 10-15 days to 4-5 weeks. and is characterized by a gradual increase in patol, changes in the most affected organs (continued devastation of the bone marrow, suppression of spermatogenesis, development of changes in small intestine and skin) at a nek-rum subsidence of the general neuroregulatory disturbances and, as a rule, satisfactory state of health of patients.

The transition to a period of pronounced wedge manifestations occurs at different times for individual tissue elements, which is associated with the duration cell cycle, as well as their unequal adaptation to the action of ionizing radiation. Leading pathogenic mechanisms are: deep damage to the blood system and intestinal tissue, immunosuppression (see Radiation Immunology), the development of infectious complications and hemorrhagic manifestations, intoxication. Duration of the period expressed by a wedge, manifestations does not exceed 2-3 weeks. By the end of this period, against the background of still pronounced cytopenia, the first signs of bone marrow regeneration appear. In this period, acute L. caused by ionizing radiation at a dose exceeding 250 rad, without holding to lay down. events possible death, the immediate causes of which are bone marrow syndrome with inherent hemorrhagic manifestations and inf. complications.

During the recovery period, the general condition of patients improves markedly, the temperature drops to normal numbers, hemorrhagic manifestations disappear, necrotic masses are rejected and shallow erosions on the skin and mucous membranes heal; from 2-5 months the function of the sweat and sebaceous glands of the skin is normalized, hair growth resumes. In general, the recovery period covers 3 months. and is characterized, especially in severe forms of L. b., by the fact that along with regeneration in damaged organs for a long time, increased exhaustion and funkts, insufficiency of regulatory processes, especially in the cardiovascular and nervous systems. Complete completion of recovery processes, depending on the severity of L. b. may take 1-3 years.

Decisive influence on L.'s current. have the conditions of radiation exposure and the magnitude of the absorbed dose. So, with prolonged exposure from several hours to 3-4 days. the primary reaction in the form of nausea, vomiting, weakness occurs later than with short-term (impulsive) exposure to the same dose, although no other differences in the course and severity of the disease are detected. With prolonged fractionated irradiation lasting more than 10 days. a clear cyclicity in the formation of the disease disappears, the primary reaction may be absent, the peak period is extended; the recovery period is slow. Patients develop a bone marrow form L. b. With subacute course varying degrees of severity; the overall severity of the disease is lower than with simultaneous exposure to the same dose. With uneven irradiation, the overall severity of lesions decreases, the main patterns of the course of the disease (cyclicity, hematopoiesis suppression) are less clearly identified, and symptoms of damage to the most irradiated organs and tissues come to the fore. With L. b., resulting from irradiation with a predominance of the neutron component, a somewhat greater intensity of the primary reaction is possible and early appearance local radiation damage to the skin, subcutaneous tissue, oral mucosa; characterized by more frequent early occurrence went.-kish. disorders. With combined gamma and beta irradiation, the wedge, the picture of the lesion consists of symptoms of acute L., combined with beta lesions of exposed skin and beta epitheliitis of the intestine. The general primary reaction is accompanied by phenomena of irritation of the conjunctiva and upper respiratory tract; more pronounced dyspeptic disorders. Skin lesions are less deep than with gamma irradiation and have a relatively favorable course. Typical long-term effects of acute L. b. are radiation cataracts (see), in severe forms there may be leukocytopenia, thrombocytopenia, moderate general asthenia and autonomic dysfunction, focal nevrol, symptoms. In some cases, there are violations of the endocrine system - hypofunction of the gonads and thyroid gland. After 6 -10 years after a single exposure, especially at doses exceeding 100 rad, some authors noted an increase in the number of cases of myeloid leukemia (see Leukemia).

Depending on the size of the absorbed radiation doses acute L. would. according to severity, they are divided into four degrees: I degree - mild (dose 100-200 rad); II degree - medium (dose 200-400 rad); III degree - severe (dose 400-600 rad); IV degree - extremely severe (dose over 600 rad). With acute L. b. mild in some patients, there may be no signs of a primary reaction, but in most a few hours after irradiation, nausea is noted, and a single vomiting is possible. With acute L. b. medium degree gravity the expressed primary reaction which is shown by hl is noted. arr. vomiting, edges comes in 1 - 3 hours and stops in 5-6 hours. after exposure. With acute L. b. severe vomiting occurs 30 minutes - 1 hour after irradiation and stops after 6 -12 hours; the primary reaction ends after 6-12 hours. With an extremely severe degree of L. b. the primary reaction begins early: vomiting occurs after 30 minutes. after irradiation, is painful, indomitable character. IV degree - an extremely severe degree of acute L. - depending on the level of doses, it manifests itself in several wedges, forms: transitional, intestinal, toxic and nervous.

Transitional (between bone marrow and intestinal) form (600 - 1000 rad): depression of hematopoiesis is the basis of its pathogenesis, however, in the wedge, the picture is dominated by signs of intestinal damage; the primary reaction lasts 3-4 days (possible development of erythema, loose stools), from the 6-8th day enterocolitis, enteritis, fever can be detected. The general course of the disease is severe, recovery is possible only with timely treatment.

Intestinal form (1000-2000 rad): the primary reaction is severe and prolonged, there is the development of erythema, loose stools; in the 1st week there are pronounced changes in the mucous membrane of the oral cavity and pharynx, the temperature is subfebrile, the stool is normalized; a sharp deterioration in the condition occurs on the 6th - 8th day of the disease - fever (up to t ° 40 °), severe enteritis, dehydration, bleeding, inf. complications.

Toxemic form (2000-5000 rad): primary reaction, as in intestinal form; immediately after exposure, a short-term collaptoid state is possible without loss of consciousness; on the 3rd-4th day. severe intoxication develops, hemodynamic disorders (weakness, arterial hypotension, tachycardia, oliguria, azotemia), from 3-5 days - cerebral and meningeal symptoms(cerebral edema).

Nervous form (with irradiation at a dose of St. 5000 rad): collapse with loss of consciousness is possible immediately after irradiation, after restoration of consciousness (in the absence of collapse - in the first minutes after exposure), debilitating vomiting and diarrhea with tenesmus occur; in the future, consciousness is disturbed, there are signs of cerebral edema, arterial hypotension, anuria progresses; death occurs on the 1-3rd day. with symptoms of cerebral edema.

Severe and extremely severe forms of L. b. complicated by local radiation damage (see), which are possible in acute L. b. lesser severity with selective overexposure individual sections body. Local beam damages have similar to the general phasing of a current, however their latent period is rather shorter and expressed a wedge. manifestations are observed in the first 7-14 days, i.e., at a time when the general signs of L. b. are weakly expressed.

Treatment

The first action after receiving information about exposure and its possible dose is the removal of the affected person from the zone of exposure to ionizing radiation; at radioactive contamination- san. treatment, decontamination of the skin and visible mucous membranes, abundant gastric lavage. Antiemetics (diphenidol, etaperazine, atropine, chlorpromazine, aeron) are used to stop the primary reaction; with prolonged indomitable vomiting and associated hypochloremia, 10% is administered intravenously chloride solution sodium, and with the threat of collapse and lowering blood pressure - reopoliglyukin or glucose in combination with mezaton or norepinephrine; with symptoms of vascular and heart failure, corglicon, strophanthin, cordiamin are prescribed.

In the latent period L. b. the patient's regimen is sparing. Apply sedatives, tranquilizers. With acute L. b. transplantation of an allogeneic or syngeneic bone marrow compatible with the AB0 system, Rh factor and typed for HLA antigens under the control of the MLC test is indicated (see Bone marrow transplantation)] the number of bone marrow cells in the transplant should be at least 10-15 billion. Bone marrow transplantation can be effective in the range of total radiation doses of 600-1000 rad.

With acute L. b. II - III degree already in the latent period, it is necessary to strive to create an aseptic regimen - dispersal of patients, placing them in isolated boxed wards equipped with bactericidal lamps, or sterile boxes (see Sterile Chamber). At the entrance to the ward, the staff puts on gauze respirators, an additional gown and shoes, which are on a rug moistened with 1% chloramine solution. The air and objects in the ward are subjected to systematic bacterial control.

Prevention inf. complications begin on the 8-15th day, depending on the predicted severity of acute L. b. and at any time with a decrease in the number of blood leukocytes to 1000 in 1 μl of blood. For prophylactic purposes, broad-spectrum bactericidal antibiotics (oxacillin, ampicillin) are used, 0.5 g orally four times a day; ampicillin can be replaced by kanamycin, which is administered intramuscularly twice a day, 0.5 g in 3-4 ml of 0.25-0.5% solution of novocaine or isotonic solution of sodium chloride. It is possible to use other antibacterial drugs, for example, long-acting sulfonamides, which are less appropriate for prophylactic purposes when predicting deep cytopenia (less than 1000 leukocytes and less than 100-500 granulocytes per 1 μl of blood). Important events warning inf. complications at patients with acute L. b., careful care of an oral cavity and a gigabyte are. treatment skin solutions of antiseptics. For the introduction of any drugs, the intravenous route is preferred using an indwelling catheter installed in the subclavian vein. Means that reduce patol, afferentations) from the affected organs and tissues are shown, especially during the development local damage- intravenous administration of novocaine solution, as well as its use in the form of regional blockades. Bandages moistened with solutions of rivanol, furacilin are applied to the affected areas of the skin. Affected areas cool available means; blisters on the skin are preserved, reducing their tension by puncture.

During the height of acute L. b. bed rest with maximum isolation of the patient is necessary to prevent exogenous infection. In cases with severe radiation damage to the oral and pharyngeal mucosa, it is advisable to prescribe nutrition through a nasal probe with fully-fledged, specially processed food. The appearance of signs of infectious complications is an indication for the use of maximum therapeutic doses bactericidal antibiotics, which are prescribed empirically even before determining the type of pathogen. The effect is evaluated by lowering the temperature, the wedge, signs of regression of the focus of inflammation and improving the general condition of the patient over the next 48 hours; with a positive effect, continue to administer drugs at a full dose until the blood picture normalizes. In the absence of obvious improvement, these antibiotics are replaced with tseporin (cephaloridine) at a dose of 3-6 g per day and gentamicin sulfate at 120-180 mg per day. By urgent indications replacement is made without taking into account data bacterial, researches, at the same time one more bactericidal antibiotic can be added. Antibiotics for treatment inf. complications are administered at intervals not exceeding 6 hours. After 7-8 days, if the symptoms of agranulocytosis persist or a new focus of inflammation occurs, the drugs are changed. To prevent a fungal infection, patients are prescribed nystatin. Carry out systematic bacteriol, researches with identification of microflora, definition of its sensitivity to antibiotics.

The higher the level of leukocytes in the blood, the more justified the use of bacteriostatic antibiotics and sulfonamides, and their parenteral administration can be replaced by oral administration. Cancellation of antibiotics is possible with a wedge, signs of elimination of foci of infection and the achievement of a level of granulocytes above 2000 in 1 μl of blood. With severe staphylococcal lesions the mucous membrane of the mouth and pharynx, with pneumonia and septicemia, the use of antistaphylococcal plasma or antistaphylococcal gamma globulin is indicated.

To combat hemorrhagic syndrome, drugs are used that compensate for platelet deficiency: native or freshly prepared blood, platelet mass (see), as well as drugs that enhance the coagulating properties of blood (aminocaproic acid, amben, dry plasma), affecting the permeability of the vascular wall ( askorutin). For nosebleeds and wound surfaces prescribe drugs local action: hemostatic sponge, fibrin film (see. Fibrin sponge, film), dry thrombin, etc.

With the development of anemia, a transfusion is carried out, including direct, one-group Rh-compatible blood (see Blood transfusion), erythrocyte mass (see), a suspension of frozen and washed erythrocytes. To combat toxemia, use intravenous drip introduction isotonic solution of sodium chloride, glucose, hemodez, rheopolyglucin and other liquids, sometimes in combination with diuretics - in the prediction and development of cerebral edema. At the expressed went. - kish. syndrome is necessary special meals(wiped beggar, enveloping agents), antispasmodics; in severe lesions of the intestine shows parenteral nutrition (see) using protein hydrolysates (see).

Swelling and increasing pain in areas that have undergone significant overexposure are indications for the use of antienzymatic drugs: contrical (trasylol) followed by an infusion of hemodez, rheopolyglucin, neocompensan and diuretics. In this case, a favorable analgesic effect occurs immediately at the time of administration, decongestant - after a certain time. In addition, agents that improve microcirculation) and metabolic processes are used: anginine (parmidine), glivenol (tribunoside), solcoseryl. With tissue necrosis and especially the appearance of signs of severe intoxication and sepsis, supported by a local infectious-necrotic process, necrectomy is indicated (see). It is desirable to carry out amputation at the 5-6th week, i.e., with an improvement in blood counts, and the volume of the operation should be reduced as much as possible. The subsequent reconstructive and plastic operations carry out depending on a wedge, indications and the forecast in several stages after completion of the recovery period.

In the recovery period with L. b. for the purpose of stabilization of a hemopoiesis and function of c. n. With. small doses of anabolic steroids are used - methandrostenolone (nerobol), retabolil, vitamins, ch. arr. group B; a diet rich in protein and iron is recommended. The motor mode under the control of general well-being and the reaction of the cardiovascular system is gradually expanding. Rational psychotherapy and the correct orientation of the patient in the labor and life prognosis are extremely important. Terms of discharge from the hospital in the absence of local lesions, as a rule, do not exceed 2-3 months. from the moment of irradiation, return to labor activity with acute L. b. II - III degree possible in 4-6 months. After inpatient treatment shows a stay in a general somatic sanatorium and subsequent dispensary observation.

Staged treatment

With the use of nuclear weapons, it is possible a large number of affected by gamma and neutron radiation. At the same time, depending on the degree of protection of people, exposure can be uniform and uneven. Acute L. b. can also occur as a result of exposure of people located in areas contaminated with nuclear explosion products (PYaV), where the severity of radiation damage mainly determines external gamma radiation, which during the period of radioactive fallout can be combined with contamination of the skin, mucous membranes and clothing PYaV, and in some cases with their penetration into the body (see Incorporation of radioactive substances).

Bibliography: Afrikanova L. A. Acute radiation injury skin, M., 1975, bibliogr.; Baysogolov G.D. To the pathogenesis of changes in the blood system during chronic radiation exposure, Med. radiol., vol. 8, no. 12, p. 25, 1963, bibliogr.; Biological effects of uneven radiation exposure, ed. N. G. Darenskoy, p. 11, M., 1974; Bond V., F l and d n e r T. and Arsh and m b o D. Radiation death of mammals, trans. from English, M., 19v 1; B about r and with about in V. P. and d river. Emergency care for acute radiation exposure, M., 1976; Vishnevsky A. A. and Shraiber M. I. Military field surgery, p. 60, M., 1975; Military Field Therapy, ed. N. S. Molchanov and E. V. Gembitsky, p. 84, L., 1973; Hemorrhagic syndrome of acute radiation sickness, ed. T. K. Jarakyan, L., 1976, bibliogr.; Guskova A. K. and B and y with about g about l about in G. D. Radiation sickness of the person, M., 1971, bibliogr.; The Action of the Atomic Bomb in Japan, ed. E. Otterson and S. Warren, trans. from English, M., 1960; The effect of ionizing radiation on the human body, ed. E. P. Cronkite and others, trans. from English, M., 1960; Ivanov A. E. Pathoanatomical changes in the lungs with radiation sickness, M., 1961, bibliogr.; Ilyin L. A. Basics of protecting the body from exposure to radioactive substances, p. 237, M., 1977; K r a e in s k and y N. A. Essays pathological anatomy radiation sickness, M., 1957, bibliogr.; Litvinov H. N. Radiation damage bone system, M., 1964, bibliogr.; Multi-volume guide to pathological anatomy, ed. A. I. Strukova, vol. 8, book. 2, p. 17, Moscow, 1962; First health care during radiation accidents, ed. G. Merle, trans. from German., M., 1975; Guide medical issues radiation protection, ed. A. I. Burnazyan, p. 149, M., 1975; Guidelines for the organization of medical support for massive defeats population, ed. A. I. Burnazyan, vol. 2, p. 55, M., 1971; Streltsov a V.N. and Moskalev Yu.I. Blastomogenic action of ionizing radiation, M., 1964, bibliogr.; T about to and I. B N. Problems of radiation cytology, M., 1974, bibliogr.; Flidner T. M. et al. Guide to radiation hematology, trans. from English, p. 62, M., 1974, bibliography; Diagnosis and treatment of acute radiation injury, Proceedings of a scientific meeting jointly sponsored by the International Atomic Energy Agency and the World Health Organization, Geneva, WHO, 1961; Histopathology of irradiation from external and internal sources, ed. by W. Bloom, N. Y. a. o., 1948.

A. K. Guskova; H. A. Kraevsky, B. I. Lebedev (stalemate. An.), E. V. Gembitsky (military.), R. G. Golodets (psychiat.).

GENERAL PRINCIPLES OF THERAPY

Treatment of acute radiation sickness is carried out in a complex manner, taking into account the form, period of the disease, severity and is aimed at stopping the main syndromes of the disease. At the same time, it should be remembered that only the bone marrow form of ARS can be treated, the therapy of the most acute forms (intestinal, vascular-toxemic and cerebral), in terms of recovery, is not yet effective all over the world.

One of the conditions determining the success of treatment is the timeliness of hospitalization of patients. Patients with bone marrow form of ARS grade IV and the most acute forms of diseases (intestinal, vascular toxemic, cerebral) are hospitalized according to the severity of the condition immediately after the lesion. Most patients with bone marrow I-III degree after stopping the primary reaction, they are able to perform official duties until signs of the height of ARS appear. In this regard, patients with ARS of the 1st degree should be hospitalized only when clinical signs of a peak or development of leukopenia appear (4-5 weeks), with moderate and severe degrees, hospitalization is desirable from the first day in a favorable environment and is strictly required from 18-20 and 7 -10 days respectively.

Measures for urgent indications are carried out in case of radiation injuries during the period of the primary reaction to radiation, the development of intestinal and cerebral syndromes, according to vital indications in case of combined radiation injuries, as well as in case of ingestion of radioactive substances.

When irradiated in doses (10-80 Gy), causing the development of an intestinal or vascular-toxemic form of acute radiation sickness, symptoms of intestinal damage, the so-called early primary radiation gastroenterocolitis, begin to come to the fore already during the primary reaction. The complex of emergency care in these cases should consist mainly of means to combat vomiting and dehydration. If vomiting occurs, the use of dimetpramide (2% solution of 1 ml) or aminazine (0.5% solution of 1 ml) is indicated. However, it should be remembered that the introduction of these drugs is contraindicated in collapse. Dinetrol is an effective means of stopping vomiting and diarrhea in the intestinal form of acute radiation sickness. In addition to antiemetic action, it has analgesic and tranquilizing effect. In extremely severe cases, accompanied by diarrhea, signs of dehydration and hypochloremia, intravenous administration of 10% sodium chloride solution, saline solution or 5% glucose solution is advisable. For the purpose of detoxification, transfusion of low molecular weight polyvinylpyrrolidol, polyglucin and saline solutions is indicated. With a sharp decrease in blood pressure, caffeine and mezaton should be administered intramuscularly. In severe cases, these drugs are administered intravenously, and with their low effectiveness, noradrenaline is added in combination with polyglucin. Can also be used camphor (subcutaneously), and with symptoms of heart failure - corglicon or strophanthin (intravenously).

An even more serious condition of patients requiring urgent interventions by medical personnel occurs when cerebral form acute radiation sickness (occurring after exposure to doses above 80 Gy). In the pathogenesis of such lesions, the leading role belongs to radiation damage to the central nervous system with early and profound impairment of its function. Patients with cerebral syndrome cannot be saved and they should be treated with symptomatic therapy aimed at alleviating their suffering (analgesics, sedatives, antiemetics, anticonvulsants).

In case of combined radiation injuries, the complex of measures provided as emergency medical care consists in combining methods and means of treating acute radiation sickness and non-radiation injuries. Depending on the specific types of injuries, as well as the leading component of the lesion in a given period, the content and sequence of assistance may vary, but in general they represent a single system of complex treatment. During the acute period (i.e. immediately and shortly after injury) with radiation-mechanical injuries, the main efforts should be directed to providing emergency and emergency care for mechanical and gunshot injuries (stopping bleeding, maintaining heart and respiratory function, anesthesia, immobilization, etc.). In severe injuries complicated by shock, it is necessary to carry out anti-shock therapy. Surgical interventions are carried out only for health reasons. At the same time, it should be borne in mind that surgical trauma can increase the severity of the syndrome of mutual burdening. Therefore, the surgical intervention should be minimal in volume and carried out under reliable anesthesia. During this period, only emergency resuscitation and anti-shock operations are performed.

In case of radiation-burn injuries, medical care in the acute period consists of anesthesia, the imposition of primary dressings and immobilization, and in case of burn shock, in addition, in anti-shock therapy. In cases where, when there are manifestations of a primary reaction to radiation, their relief is indicated. The use of antibiotics in the acute period is primarily aimed at preventing the development of wound infection.

When radioactive substances enter the gastrointestinal tract, emergency care consists of measures aimed at preventing their absorption into the blood and accumulation in the internal organs. To do this, the victims are prescribed adsorbents. At the same time, it should be remembered that adsorbents do not have polyvalent properties and in each individual case it is necessary to use appropriate adsorbents that are effective for binding a particular type of radioisotope. For example, when strontium and barium isotopes enter the gastrointestinal tract, adsorbar, polysurmin, highly oxidized cellulose and calcium alginate are effective; when radioactive iodine enters the body - stable iodine preparations. To prevent the absorption of cesium isotopes, the use of ferrocin, bentonite clay, vermiculite (hydromica), Prussian blue is shown. Such well-known sorbents as activated carbon (carbolene) and white clay are practically ineffective in these cases due to the fact that they are not able to capture small amounts of substances. Ion-exchange resins are used with great success for these purposes. Radioactive substances in the cationic (for example, strontium-90, barium-140, polonium-210) or anionic (molybdenum-99, tellurium-127, uranium-238) form replace the corresponding group in the resin and bind to it, which reduces 1.5-2 times their resorption in the intestine.

Adsorbents should be applied immediately after establishing the fact of internal contamination, since radioactive substances are absorbed very quickly. So, when uranium fission products get inside, after 3 hours up to 35-50% of radioactive strontium has time to be absorbed from the intestine and deposited in the bones. Radioactive substances are absorbed very quickly and in large quantities from wounds, as well as from the respiratory tract. Isotopes deposited in tissues and organs are very difficult to remove from the body.

After the use of adsorbents, it is necessary to take measures to free the gastrointestinal tract from the contents. Optimal time for this are the first 1-1.5 hours after the incorporation of radionuclides, but without fail this should be done at a later date. Apomorphine and some other drugs that cause vomiting are effective means for releasing the contents of the stomach. With contraindications to the use of apomorphine, it is necessary to wash the stomach with water.

Since isotopes can linger in the intestines for a long time, especially in the large intestine (for example, poorly absorbed transuranium and rare earth elements), siphon and conventional enemas must be administered to clean these sections of the intestinal tract, as well as saline laxatives.

In case of inhalation contamination with radioactive substances, the victims are given expectorants and the stomach is washed. When prescribing these procedures, it should be remembered that 50-80% of the radionuclides that linger in the upper respiratory tract soon enter the stomach as a result of swallowing sputum. In some cases, it is advisable to use inhalation in the form of aerosols substances that are able to bind radioisotopes and form complex compounds. Subsequently, these compounds are absorbed into the blood and then excreted in the urine. Similar assistance should be provided when radioactive substances enter the blood and lymph, i.e. at a later stage after infection. For these purposes, it is recommended to prescribe pentacin (trisodium calcium salt of diethylenetriaminepentaacetic acid), which has the ability to bind such radionuclides as plutonium, transplutonium elements, radioactive isotopes of rare earth elements, zinc and some others into stable non-dissociating complexes.

To prevent the absorption of radioactive substances from wound surfaces, the wounds must be washed with an adsorbent or saline solution.

IN THE PERIOD OF THE PRIMARY REACTION of the bone marrow form of ARS, treatment is carried out in order to preserve the combat and working capacity of the victim and early pathogenetic therapy. The first includes the use of antiemetics, psychostimulants (dimetpramide, dimetkarb, dixafen, methaclopramide, diphenidol, atropine, chlorpromazine, aeron, etc.). To prevent nausea and vomiting, it is taken orally a tablet of dimetcarb or dimedpramide 20 mg 3 times a day, as well as chlorpromazine (especially against the background of psychomotor agitation) 25 mg 2 times a day. With developed vomiting, dimetpramide is administered intramuscularly in 1 ml of a 2% solution or dixafen in 1 ml, or aminazine in 1 ml of a 0.5% solution, or subcutaneously atropine in 1 ml of a 0.1% solution. Cordiamin, caffeine, camphor can be used to combat hemodynamic disorders, with collapse - prednisolone, mezaton, norepinephrine, polyglucin, with heart failure - corglicon, strophanthin). With indomitable vomiting, diarrhea and symptoms of dehydration - 10% sodium chloride solution, saline.

The basis of the early pathogenetic therapy are the development of post-radiation toxicosis and inhibition of cell proliferation processes, accompanied by a decrease in the synthesis of protective proteins, suppression of phagocytosis, the function of immunocompetent cells, etc. This therapy consists of detoxifying, antiproteolytic therapy, the use of agents that restore microcirculation, stimulate hematopoiesis and nonspecific immunological resistance of the body.

Post-radiation toxicosis develops immediately after irradiation as a result of the accumulation of so-called radiotoxins in cells and tissues, which, depending on the timing of appearance and chemical nature, are divided into primary and secondary. Primary radiotoxins include products of water radiolysis, substances of a quinoid nature, and compounds that appear during lipid oxidation (aldehydes, ketones, etc.). Secondary radiotoxins are the result of the decay of radiosensitive tissues; predominantly, these are the products of oxidation of phenolic and hydroaromatic compounds formed in excess. They appear at the later stages of the formation of radiation injury as a result of deep biochemical changes in the metabolism and physiological disorders. Radiotoxins, having high biological activity, can cause breaks of chemical bonds in DNA molecules and prevent their repair, contribute to the occurrence of chromosomal aberrations, damage the structure of cell membranes, and suppress cell division processes.

The means and methods of pathogenetic therapy are aimed at preventing the occurrence or reducing the formation of toxic products, inactivating or reducing their activity, and increasing the rate of elimination of toxins from the body. The latter can be achieved by forcing diuresis using osmotic diuretics. However, since these measures can cause undesirable shifts in the water-electrolyte balance, at present, in the system of combating early post-radiation toxemia, preference is given to detoxifiers - plasma substitutes of hemodynamic, detoxification and polyfunctional action. Among the first, in the mechanism of action of which the main role is played by the effect of "dilution" of the concentration of toxins and the acceleration of their elimination, are polyglucin, reopoliglyukin and some other drugs based on dextran. The introduction of these drugs not only provides a dilution of the concentration of radiotoxins, but also binds them. Polyvinylpyrrolidone derivatives gemodez (6% PVP solution), aminodez (a mixture of PVP, amino acids and sorbitol), gluconodesis (a mixture of PVP and glucose), preparations based on low molecular weight polyvinyl alcohol - polyvisoline (a mixture of NSAIDs, glucose, potassium, sodium and magnesium salts), rheogluman (10% dextran solution with the addition of 5% mannitol), in addition to the complexing action, also has a pronounced hemodynamic effect, which helps to improve blood microcirculation and improve lymph flow, reduce blood viscosity, and inhibit the processes of aggregation of formed elements.

Many detoxifiers-plasma substitutes have an immunocorrective effect (stimulate the system of mononuclear phagocytes, interferon synthesis, migration and cooperation of T- and B-lymphocytes), which ensures a more favorable course of post-radiation repair processes.

Very effective are the methods of extracorporeal sorption detoxification - hemosorption and plasmapheresis. At present, the positive effect of hemosorption has already been confirmed by a large practice in the treatment of patients with acute radiation injury, but this procedure causes a number of undesirable consequences (increases thrombus formation, hypovolemia, increases blood viscosity, hypotension, causes nausea, chills). Plasmapheresis is more promising in this regard, it is a transfusiological procedure, which consists in removing a certain volume of plasma from the bloodstream while replenishing with an adequate amount of plasma-substituting fluids. Plasmapheresis in the first 3 days after irradiation, in the mechanisms of therapeutic action of which, it is believed, not only the elimination of antigens and autoimmune complexes, decay products of radiosensitive tissues, inflammatory mediators and other "radiotoxins", but also the improvement of the rheological properties of blood. Unfortunately, the methods of extracorporeal detoxification are very laborious and therefore can be applied mainly at the stage of specialized medical care, if the appropriate forces and means are available.

The development of toxemia and microcirculation disorders in the first days after irradiation is partly associated with the activation of proteolytic enzymes and disseminated intravascular coagulation. To mitigate these disorders, the use of protease inhibitors (kontrykal, trasilol, gordox, etc.) and direct anticoagulants (heparin) during the first 2-3 days of the irradiation field in radiation sickness III-IV degrees is indicated.

In addition to detoxifiers, a large group of drugs used in the early stages after irradiation are biologically active substances of natural and synthetic origin: cytokines, interferon inducers, polyribonucleotides, nucleosides, coenzymes, some hormonal drugs.

The mechanisms of their anti-radiation action are associated with an increase in radioresistance of tissues by activating the processes of migration of lymphoid cells to the bone marrow, an increase in the number of receptors on immunocompetent cells, an increase in the interaction of macrophages with T- and B-lymphocytes, an increase in the proliferation of hematopoietic stem cells, and activation of granulocytopoiesis. At the same time, the synthesis of gamma globulin, nucleic acids and lysosomal enzymes is stimulated, the phagocytic activity of macrophages is enhanced, the production of lysozyme, beta-lysines, etc. is increased. Some macromolecular compounds (polysaccharides, exogenous RNA and DNA) are also capable of absorbing and inactivating radiotoxins.

Carrying out early pathogenetic therapy, as a rule, will be carried out only in hospitals.

IN THE HIDDEN PERIOD

In the latent period, sanitation of possible foci of infection is carried out. Sedatives, antihistamines (phenazepam, diphenhydramine, pipolfen, etc.), vitamin preparations (group B, C, P) can be prescribed. In some cases, with an extremely severe degree of acute radiation sickness from relatively uniform irradiation (the dose is equal to or more than 6 Gy), if possible, on days 5-6, it is possible earlier, after irradiation, transplantation of an allogeneic or syngeneic (previously harvested) can be performed. from the injured and preserved) bone marrow. Allogeneic bone marrow should be selected according to the ABO group, Rh factor and typed according to the HLA antigenic system of leukocytes and the lymphocytic MS test. The number of cells in the transplant should be at least 15-20 billion. Transplantation is usually carried out by intravenous injection of bone marrow. When transplanting bone marrow to an irradiated person, we can count on three effects: engraftment of the transplanted bone marrow of a donor with subsequent reproduction of stem cells, stimulation of the remnants of the victim's bone marrow, and replacement of the affected bone marrow with a donor one without its engraftment.

Engraftment of donor bone marrow is possible almost against the background of complete suppression of the immune activity of the irradiated person. Therefore, bone marrow transplantation is performed with active immunosuppressive therapy with antilymphocyte serum or 6% antilymphocyte globulin solution using corticosteroid hormones. The engraftment with the production of full-fledged cells occurs no earlier than 7-14 days after transplantation. Against the background of an accustomed transplant, the revival of the remnants of the irradiated hematopoiesis can occur, which inevitably leads to an immune conflict between one's own bone marrow and the engrafted donor's. In international literature, this is called a secondary disease (foreign transplant rejection disease), and the effect of temporary engraftment of a donor's bone marrow in the body of an irradiated person is called "radiation chimeras". To enhance reparative processes in the bone marrow in patients who received sublethal doses of radiation (less than 6 Gy), untyped allogeneic bone marrow compatible with ABO and Rh factor at a dose of 10-15x10 9 cells can be used as a stimulating hematopoiesis and replacement agent. At the end of the latent period, the patient is transferred to a special mode. In anticipation of agranulocytosis and during it, to combat exogenous infection, it is necessary to create an aseptic regimen: bedding with maximum isolation (dispersal of patients, boxed wards with bactericidal lamps, aseptic boxes, sterile wards).

DURING THE HIGH PERIOD, therapeutic and preventive measures are carried out primarily aimed at:

Replacement therapy and restoration of hematopoiesis;

Prevention and treatment of hemorrhagic syndrome;

Prevention and treatment of infectious complications.

Treatment of acute radiation sickness should be carried out intensively and comprehensively using not only pathogenetically substantiated means, but also symptomatic drug therapy.

The staff, before entering the ward to the patient, puts on gauze respirators, an additional gown and shoes located on a rug moistened with a 1% chloramine solution. Systematic bacterial control of air and items in the ward is carried out. Careful oral care, hygienic treatment of the skin with a solution of antiseptics is necessary. When choosing antibacterial agents, one should be guided by the results of determining the sensitivity of the microorganism to antibiotics. In cases where individual bacteriological control is not possible (for example, with a massive influx of affected patients), it is recommended to selectively determine antibiotic sensitivity to microorganisms isolated from individual victims.

For the treatment of this contingent of patients, antibiotics should be used, to which the most common pathogenic strain of the microbe is sensitive. If bacteriological control is not possible, antibiotics are prescribed empirically, and the therapeutic effect is assessed by body temperature and clinical symptoms characterizing the severity of the infectious process.

Prevention of agranulocytic infectious complications begins within 8-15 days, depending on the severity of ARS (stage II-III) or a decrease in the number of leukocytes less than 1x10 9 /l with maximum doses of bactericidal antibiotics, which are prescribed empirically even before determining the type of pathogen

The use of sulfonamides, due to the fact that they increase granulocytopenia, should be avoided, they are used only in the absence of antibiotics. Antibiotics of choice are semi-synthetic penicillins (ocacillin, methicillin, ampicillin 0.5 orally 4 times a day, carbenicillin). The effect is assessed by the clinical manifestations of the first 48 hours (decrease in fever, disappearance or smoothing of focal symptoms of infection). If there is no effect, it is necessary to replace these antibiotics with tseporin (3-6 g per day) and gentamicin (120-180 mg per day), ampiox, kanamycin (0.5 2 times a day), doxycycline, carbenicillin, lincomycin, rimfampicin. The replacement is made empirically, without taking into account the data of bacteriological studies. If successful, continue the introduction of the drug until the exit from agranulocytosis - an increase in the content of leukocytes in the peripheral blood to 2.0-3.0x10 9 /l (7-10 days). The emergence of a new focus of inflammation on this antibiotic regimen requires a change in drugs. If possible, regular bacteriological examination is carried out, while antibiotic therapy becomes targeted. Antibiotics are administered (including penicillin up to 20 million units per day) at intervals not exceeding 6 hours. If there is no effect, you can add another antibiotic, for example, carbencillin (20 grams per course), reverin, gentomycin. To prevent superinfection with fungi, nystatin is prescribed 1 million units per day 4-6 times or levorin or amphitericin. In severe staphylococcal lesions of the mucosa of the mouth and pharynx, pneumonia, septicemia, antistaphylococcal plasma or antistaphylococcal gamma globulin, other directional globulins are also indicated. In acute radiation sickness of 2 and 3 degrees, it is desirable to introduce agents that increase the nonspecific resistance of the body.

To combat hemorrhagic syndrome, drugs are used in appropriate doses that compensate for platelet deficiency. First of all, it is a platelet mass. Previously, it (300x109 cells in 200-250 ml of plasma per transfusion) is irradiated at a dose of 15 Gy to inactivate immunocomponent cells. Transfusions begin with a decrease in the number of platelets in the blood less than 20x10 9 cells / l. In total, each patient produces from 3 to 8 transfusions. In addition, in the absence of platelet mass, direct blood transfusions, native or freshly prepared blood for no more than 1 day of storage are possible (the presence of a stabilizer and storage of blood for a longer time increase the hemorrhagic syndrome in ARS and transfusion of such blood is not desirable, except in cases of anemic bleeding). Also used are agents that enhance blood coagulation (aminocaproic acid, amben), affecting the vascular wall (serotonin, dicynon, ascorutin). When bleeding from the mucous membranes, local hemostatic agents should be used: thrombin, a hemostatic sponge, tampons moistened with a solution of epsilon-aminocaproic acid, as well as dry plasma (it can be topically - with nosebleeds, wounds)

In case of anemia, blood transfusions of single-group Rh-compatible blood are necessary, preferably - erythrocyte mass, erythropoiesis, direct transfusions of freshly prepared blood for no more than 1 day of storage. Hematopoietic stimulants are not prescribed during the peak period. Moreover, leukopoiesis stimulants pentoxyl, sodium nucleinate, tezan-25 cause depletion of the bone marrow and aggravate the course of the disease. To eliminate toxemia, an isotonic sodium chloride solution, 5% glucose solution, gemodez, polyglucin and other liquids are dripped into the vein, sometimes in combination with diuretics (lasix, mannitol, etc.), especially with cerebral edema. Doses control the volume of diuresis and indicators of the electrolyte composition.

With a pronounced oropharyngeal and gastrointestinal syndrome - nutrition through a permanent (anorexia) nasal probe (special nutrition, pureed food), prescribe pepsin, antispasmodics, pancreatin, dermatol, calcium carbonate in generally accepted doses. With oropharyngeal syndrome, in addition, treatment of the oral cavity is necessary. antiseptic solutions and praparats accelerating reparative processes (peach and sea buckthorn oil).

In severe intestinal lesions - parenteral nutrition (protein hydrolysates, fat emulsions, polyamine mixtures), starvation. If necessary, symptomatic therapy: vascular insufficiency- mezaton, norepinephrine, prednisolone; with heart failure - corglicon or strophanthin.

IN THE RECOVERY PERIOD, in order to stabilize and restore hematopoiesis and CNS function, small doses of anabolic steroids (nerobol, retabolil), tezan, pentoxyl, lithium carbonate, nucleic acid sodium, securinin, bemitil are prescribed; vitamins of groups B, A, C, R. The patient receives a diet rich in protein, vitamins and iron (diet 15, 11b); gradually the patient is transferred to a general regimen, antibacterial (when the number of leukocytes reaches 3x10 9 /l and more hemostatic (when the number of platelets increases to 60-80 thousand in 1 μl) are canceled, rational psychotherapy is carried out, and he is correctly oriented in work and life mode The terms of discharge from the hospital do not exceed 2.5-3 months for ARS grade III, 2-2.5 months for grade II ARS, and 1-1.5 months for grade I ARS.

Treatment of those affected by ionizing radiation at the stages of medical evacuation is carried out in accordance with the main directions of ARS therapy, taking into account the intensity of the flow of the injured, the prognosis for life, the regular and personnel capabilities of the stage.

FIRST MEDICAL AID is provided immediately after radiation damage in the order of self- and mutual assistance. Are taken orally means of preventing the primary reaction - dimetkarb, with developed vomiting and hypodynamia - dixafen in / m; when skin and clothes are contaminated with RV - partial sanitization; in case of danger of further irradiation (being on the ground) of contaminated RS, a radioprotector - cystamine or B-130 is taken orally.

PRE-MEDICAL ASSISTANCE is provided by a paramedic or medical instructor. With developed vomiting and hypodynamia - dimetpramide or dixafen in / m; with cardiovascular insufficiency - cordiamin s / c; caffeine i / m; with psychomotor agitation inside - phenazepam; if necessary, further stay in the zone of increased radiation inside - cystamine or B-130; when skin or clothes are contaminated with RV - partial sanitization.

FIRST MEDICAL AID is carried out at the WFP. Proper, fast and accurate triage is of great importance. At the sorting post, the affected, contaminated with RS, are isolated and sent to the site for partial sanitization (PSO). All the rest, as well as those affected after PSO, are examined by a doctor at the triage yard as part of the medical team (doctor, nurse, registrar). Those who are injured and need emergency care are identified.

Urgent first aid measures include: the introduction of severe vomiting - dimetpramide / m, with indomitable vomiting - dixaphene / m or atropine s / c, with severe dehydration - drinking plenty of salted water, saline s / c and / in ; in acute vascular insufficiency - cordiamin s / c, caffeine / m or mezaton / m; in heart failure - corglicon or strophanthin IV; with convulsions - phenazepam or barbamil i / m.

Delayed therapeutic measures include the appointment of febrile patients inside ampicillin or oxacillin, penicillin in / m; with the severity of bleeding, EACC or amben i / m.

Patients with ARS stage I (dose - 1-2 Gy) after stopping the primary reaction, they are returned to the unit; in the presence of manifestations of the height of the disease, as well as all patients with ARS of a more severe degree (dose more than 2 Gy), they are referred to the OMEDB (OMO) for qualified assistance.

QUALIFIED MEDICAL CARE. Upon admission to the OMEB of those affected by ionizing radiation, in the process of their sorting, victims are identified with contamination of the skin and uniforms with RV in excess of the permissible level. They are sent to the OSO, where a complete sanitization is carried out and, if necessary, emergency assistance is provided. In the sorting and evacuation department, the form and severity of ARS, the state of transportability are determined. Non-transportable affected (acute cardiovascular failure, indomitable vomiting with signs of dehydration) are sent to the anti-shock department, patients with signs of severe toxemia, psychomotor agitation, convulsive-hyperkinetic syndrome - to the hospital department. Patients with ARS stage I (dose 1-2 Gy) after stopping the primary reaction, they are returned to their unit. All patients with a more severe degree of ARS (dose over 2 Gy), with the exception of those with a cerebral form of radiation sickness, are evacuated to therapeutic hospitals; patients with ARS stage I during the height of the disease, they are evacuated to VPGLR, with II-IY st. - in therapeutic hospitals.

Measures of emergency qualified medical care:

with a pronounced primary reaction (persistent vomiting) - dimetpramide or dixafen intramuscularly or atropine s / c, in case of severe dehydration, sodium chloride solutions, hemodez, reopoliglyukin - all intravenously.

with cardiovascular insufficiency - mezaton in / m or norepinephrine in / in with glucose solution, in case of heart failure - corglicon and strophanthin intravenously in a glucose solution;

with anemic bleeding - EACC or amben IV, locally - thrombin, hemostatic sponge, as well as transfusion of red blood cells or freshly prepared blood (direct blood transfusions);

in severe infectious complications - ampicillin with oxacillin or rifampicin or penicillin, or erythromycin inside.

Delayed qualified assistance measures include the appointment of:

when excited - phenazepam, oxylidine inside;

with a decrease in the number of leukocytes to 1x10 9 / l and fever - tetracycline, sulfonamides inside;

in the latent period - multivitamins, diphenhydramine, plasma transfusion, polyvinylpyrrolidone and polyglucin every other day;

in the cerebral form of ARS to alleviate suffering - phenazepam IM, barbamil IM, Promedol SC.

After the provision of qualified assistance and preparation for evacuation, ARS patients are evacuated to the hospital base.

SPECIALIZED MEDICAL CARE is provided in therapeutic hospitals. In addition to the activities of qualified assistance in the initial period for ARS II-III Art. hemosorption can be carried out, in the latent period, patients with stage IY. ARS (dose 6-10 Gy) - transplantation of allogeneic bone marrow, and in the peak period with the development of agranulocytosis and deep thrombocytopenia and severe enteritis - placement of patients in aseptic wards, tube or parenteral nutrition, transfusion of leukoconcentrates and platelet mass obtained by cell separation.

Staged treatment of combined and combined radiation injuries has a number of features.

With PSA incorporation, in addition to the treatment of ARS, medical care measures are taken to remove RV that have entered the body: gastric lavage, the appointment of laxatives, adsorbents, cleansing enemas, expectorants, diuretics, the introduction of complexones (EDTA, pentacin, etc.). With betadermatitis - anesthesia (novocaine blockade, local anesthetic), dressings with antibacterial agents, etc.

With CRP, it is necessary to combine the complex therapy of radiation sickness with the treatment of non-radiation injuries. Surgical treatment must be completed in the latent period of radiation sickness, during the height of the operation is carried out only for health reasons. A feature of the treatment of CRP in the initial and latent periods of radiation sickness is the prophylactic administration of antibiotics (before the onset of infectious processes and agranulocytosis).

At the height of the disease, special attention is paid to the prevention and treatment of wound infection and the prevention of bleeding from wounds (the use of fibrin and hemostatic sponge, dry thrombin).

After completion of treatment of patients with ARS, a military medical examination is carried out to determine the suitability for further service in the Armed Forces.