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20.10.2017

Ionizing radiation causes a number of changes in the body; doctors call this complex of symptoms radiation sickness. All signs of radiation sickness are distinguished depending on the type of radiation, its dosage and the location of the harmful source. Due to harmful radiation, processes begin to occur in the body that threaten the functioning of systems and organs.

Pathology is included in the list of diseases, because of it irreversible processes develop. The current level of medicine allows us to slow down destructive processes in the body, but not to cure a person. The severity of this disease depends on what area of the body was irradiated, for how long and how exactly it reacted the immune system person.

Doctors distinguish between forms of pathology when the irradiation was general and local, and also distinguish between combined and transitional types of pathology. Due to penetrating radiation, oxidative processes begin in the cells of the body, as a result they die. Metabolism is seriously impaired.

The main impact of radiation falls on the gastrointestinal tract, nervous and circulatory systems, spinal cord. When systems are disrupted, dysfunction occurs in the form of combined and isolated complications. A complex complication occurs with grade 3 damage. Such cases end fatally.

The pathology occurs in a chronic form; the doctor can determine what radiation sickness is in a specific form based on the magnitude and duration of exposure. Each form has a development mechanism, so the transition of the identified form to another is excluded.

Types of harmful radiation

In the development of pathology, an important role is assigned to a specific type of radiation; each has specific effects on different organs.

The main ones are listed:

alpha radiation. It is characterized by high ionization, but low ability to penetrate deep into tissues. Sources of such radiation are limited in their damaging effects;
beta radiation. Characterized by weak ionizing and penetrating ability. Usually it affects only those parts of the body to which the source of harmful radiation is closely adjacent;
gamma and x-ray radiation. Such types of radiation are capable of affecting tissue to a significant depth in the source area;
neutron radiation. It differs in its penetrating ability, which is why organs are affected heterogeneously by such irradiation.

If the radiation reaches 50-100 Gy, then the main manifestation of the disease will be damage to the central nervous system. You can live with such symptoms for 4-8 days.

With irradiation of 10-50 Gy, the gastrointestinal tract is more damaged, the intestinal mucosa is rejected and death occurs within 2 weeks.

With minor exposure (1-10 Gy), the symptoms of radiation sickness are manifested by bleeding and hematological syndromes, as well as infectious complications.

What causes radiation sickness?

Irradiation can be external or internal, depending on how the radiation enters the body - transdermally, with air, through the gastrointestinal tract, mucous membranes or in the form of injections. Low doses of radiation always affect a person, but pathology does not develop.
The disease is said to occur when the radiation dose is 1-10 Gy or more. Among those who risk learning about the pathology called radiation sickness, what it is and why it is dangerous, there are groups of people:

those receiving low doses of radiation in medical institutions (X-ray staff and patients who must undergo examinations);
who received a single dose of radiation during experiments, during man-made disasters, from the use of nuclear weapons, during the treatment of hematological diseases.

Signs of radiation exposure

When radiation sickness is suspected, symptoms appear depending on the dose of radiation and the severity of complications. Doctors distinguish 4 phases, each with its own symptoms:

- The first phase occurs in people who have received radiation at a dosage of 2 Gy. Appearance speed clinical signs depends on the dose and is measured in hours and minutes. Main symptoms: nausea and vomiting, dryness and bitterness in the mouth, increased fatigue and weakness, drowsiness and headaches. Revealed state of shock, in which the victim faints, an increase in temperature, a drop in pressure, and diarrhea may be detected. Such clinical picture typical for irradiation at a dosage of 10 Gy. Victims have red skin in those areas that were in contact with radiation. There will be a change in pulse, low blood pressure, trembling fingers. On the first day after irradiation, the number of lymphocytes in the blood drops - the cells die.

The second phase is called sluggish. It begins after the first phase has passed - approximately 3 days after irradiation. The second stage lasts up to 30 days, during which the state of health returns to normal. If the radiation dosage is more than 10 Gy, then the second phase may be absent, and the pathology passes into the third. The second phase is characterized by skin lesions. This indicates an unfavorable course of the disease. A neurological clinic appears - the whites of the eyes tremble, the physical activity, reflexes are reduced. By the end of the second stage, the vascular wall becomes weak, blood clotting slows down.
The third stage is characterized by the clinical picture of the disease. The timing of its onset depends on the radiation dose. Phase 3 lasts 1-3 weeks. Become noticeable: damage circulatory system, decreased immunity, autointoxication. The phase begins with a serious deterioration in health, fever, increased heart rate and a drop in blood pressure. The gums bleed and the tissues swell. The mucous membranes of the gastrointestinal tract and mouth are affected, and ulcerations appear. If the radiation dose is low, the mucous membrane will recover over time. If the dose is high, the small intestine is damaged, which is characterized by bloating and diarrhea, and abdominal pain. Infectious sore throats and pneumonia occur, and the hematopoietic system is inhibited. The patient has hemorrhages on the skin, digestive organs, mucous membrane of the respiratory system, and ureters. The bleeding is quite severe. The neurological picture is manifested by weakness, confusion, and meningeal manifestations.
In the fourth stage, the structures and functions of organs improve, bleeding disappears, lost hair begins to grow, and damaged skin heals. The body takes a long time to recover, more than 6 months. If the radiation dose was high, rehabilitation may take up to 2 years. If the last, fourth, phase is over, we can say that the person has recovered. Residual effects may manifest as pressure surges and complications in the form of neuroses, cataracts, leukemia.

Variants of radiation sickness

Diseases are classified by type based on the duration of exposure to radiation and dose. If the body is exposed to radiation, they speak of an acute form of pathology. If the radiation is repeated in small doses, they speak of a chronic form.
Depending on the dosage of radiation received, there are following forms lesions:

- less than 1 Gy – radiation injury with reversible damage;
- from 1-2 to 6-10 Gy – typical shape, another name is bone marrow. Develops after short-term exposure to radiation. Mortality occurs in 50% of cases. Depending on the dosage, they are divided into 4 degrees - from mild to extremely severe;
- 10-20 Gy – gastrointestinal form, resulting from short-term irradiation. Accompanied by fever, enteritis, septic and infectious complications;

20-80 Gy – toxemic or vascular form, arising from simultaneous irradiation. Accompanied by hemodynamic disturbances and severe intoxication;
over 80 Gy – cerebral form, when death occurs within 1-3 days. The cause of death was cerebral edema.

The chronic course of pathology is characterized by 3 periods of development - in the first, a lesion is formed, in the second, the body is restored, in the third, complications and consequences arise. The first period lasts from 1 to 3 years, during which the clinical picture develops with of varying severity manifestations.

The second period begins when radiation stops affecting the body or the dosage is reduced. The third period is characterized by recovery, then partial recovery, and then stabilization of positive changes or progression.

Treatment of radiation sickness

Irradiation with a dosage of more than 2.5 Gy is fraught with death. From a dose of 4 Gy the condition is considered fatal. Timely and competent treatment Radiation sickness from exposure to a dose of 5-10 Gy still gives a chance for clinical recovery, but usually a person dies from a dose of 6 Gy.

When radiation sickness is established, treatment in the hospital is reduced to an aseptic regimen in the rooms designated for this. Also shown symptomatic therapy and prevention of the development of infections. If fever and agranulocytosis are detected, antibacterial and antiviral drugs are prescribed.

The following drugs are used in treatment:

Atropine, Aeron – stop nausea and vomiting;
saline solution – against dehydration;
Mezaton - for detoxification on the first day after irradiation;
gamma globulin increases the effectiveness of anti-infective therapy;
antiseptics for treating mucous membranes and skin;
Kanamycin, Gentamicin and antibacterial drugs suppress the activity of intestinal flora;
donor platelet mass, irradiated with a dose of 15 Gy, is administered to replace the deficiency in the victim. If necessary, red blood cell transfusions are prescribed;
local and overall impact to combat bleeding;
Rutin and vitamin C, hormones and other medications that strengthen the walls of blood vessels;
Fibrinogen to increase blood clotting.

In the room where patients with radiation sickness are being treated, infections are prevented (both internal and external), sterile air is supplied, the same applies to food and materials.

At local lesion their mucous membranes are treated with mucolytics bactericidal action. Lesions on the skin are treated with collagen films and special aerosols, bandages with tannins and antiseptic solutions. Dressings with Hydrocortisone ointment are shown. If ulcers and wounds do not heal, they are excised and plastic surgery is prescribed.

If the patient develops necrotizing enteropathy, antibacterial drugs and Biseptol are prescribed to sterilize the gastrointestinal tract. At this time, the patient is advised to fast. You can drink water and take anti-diarrhea medications. In severe cases, parenteral nutrition is prescribed.

If the radiation dosage was high, the victim has no contraindications, a suitable donor has been found, and transplantation is indicated bone marrow. The reason for the procedure is a disruption of the hematopoietic process and suppression of the immunological reaction.

Complications of radiation sickness

The patient's health condition can be predicted taking into account the degree of radiation exposure and the duration of the harmful effects on the body. Those patients who survive 12 weeks after radiation have a good chance. This period is considered critical.

Even from radiation that is not fatal, complications of varying severity develop. It will be malignancy, hemoblastosis, inability to have children. Long-term disorders can manifest themselves in offspring at the genetic level.

The victim's chronic infections. Gets cloudy vitreous and lens, vision is impaired. In the body are detected dystrophic processes. Contacting the clinic will give you the maximum chance to prevent the development of consequences.

Radiation sickness is considered severe and dangerous pathology, which manifests itself as a complex various symptoms. While doctors have not developed a treatment, treatment is aimed at maintaining the body and reducing negative manifestations.

Of primary importance in preventing such illness is exercising caution near potential sources of hazardous radiation.

GENERAL PRINCIPLES OF THERAPY

Treatment of acute radiation sickness is carried out comprehensively, taking into account the form, period of the disease, severity and is aimed at relieving the main syndromes of the disease. It should be remembered that only the bone marrow form of ARS can be treated; therapy for the most acute forms (intestinal, vascular toxicemic and cerebral) is not yet effective in terms of recovery all over the world.

One of the conditions that determines the success of treatment is the timely hospitalization of patients. Patients with the bone marrow form of ARS IY degree 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 the bone marrow form I-III degrees after relief of the primary reaction, they are able to perform official duties until signs of the height of ARS appear. In this regard, patients with stage I ARS should be hospitalized only when clinical signs of the height or development of leukopenia appear (week 4-5); for moderate and severe degrees, hospitalization is desirable from the first day in a favorable environment and is strictly required from the 18th-20th and 7th -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, for health reasons in case of combined radiation injuries, as well as in case of ingestion of radioactive substances.

When irradiated in doses (10-80 Gy) that cause the development of intestinal or vascular-toxic forms of acute radiation sickness, already during the period of the primary reaction, symptoms of intestinal damage, the so-called early primary radiation gastroenterocolitis, begin to come to the fore. Complex emergency care in these cases, it should consist mainly of means to combat vomiting and dehydration. If vomiting occurs, the use of dimetpramide (2% solution 1 ml) or aminazine (0.5% solution 1 ml) is indicated. However, it should be remembered that the administration of these drugs is contraindicated in case of collapse. An effective means of relieving vomiting and diarrhea in intestinal form acute radiation sickness is Dinetrol. In addition to the antiemetic effect, it has an analgesic and tranquilizing effect. In extremely severe cases, accompanied by diarrhea, signs of dehydration and hypochloremia, it is advisable intravenous administration 10% sodium chloride solution, saline solution or 5% glucose solution. For the purpose of detoxification, transfusion of low molecular weight polyvinylpyrrolidol, polyglucin and saline solutions is indicated. If there is a sharp decrease in blood pressure, caffeine and mesaton should be prescribed intramuscularly. In severe cases, these drugs are administered intravenously, and if their effectiveness is low, norepinephrine is added dropwise in combination with polyglucin. Camphor can also be used (subcutaneously), and in cases of heart failure - corglycone 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, a set of measures provided as emergency medical care consists of 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 components of the lesion in a given period, the content and sequence of assistance may vary, but in general they represent unified system complex treatment. During the acute period (i.e. immediately and shortly after injury) in case of radiation-mechanical injuries, the main efforts should be aimed at providing emergency and emergency care for mechanical and gunshot injuries (stopping bleeding, maintaining cardiac and respiratory function, pain relief, immobilization, etc.). For severe injuries complicated by shock, it is necessary to carry out anti-shock therapy. Surgical interventions are performed only for health reasons. It should be borne in mind that surgical trauma can increase the severity of mutual burden syndrome. Therefore, 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.

For radiation burn injuries health care in the acute period consists of anesthesia, application of primary dressings and immobilization, and in case of burn shock, in addition, in anti-shock therapy. In cases where 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. For this purpose, the victims are prescribed adsorbents. 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 specific type of radioisotope. For example, when strontium and barium isotopes enter the gastrointestinal tract, adsorbar, polysurmine, 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 ferrocine, bentonite clay, vermiculite (hydromica), and Prussian blue is indicated. 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. Radio active substances, which are in 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 by 1 ,5-2 times their resorption in the intestine.

Adsorbents should be used immediately after establishing the fact of internal contamination, since radioactive substances are absorbed very quickly. Thus, when uranium fission products are ingested, within 3 hours up to 35-50% of radioactive strontium has time to be absorbed from the intestines 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 using adsorbents, it is necessary to take measures to empty the gastrointestinal tract of its contents. Optimal time for this purpose are the first 1-1.5 hours after the incorporation of radionuclides, but in mandatory this should be done in more late dates. Effective means for emptying the stomach of contents are apomorphine and some other drugs that cause vomiting. If the use of apomorphine is contraindicated, it is necessary to perform gastric lavage with water.

Since isotopes can remain for a long time in the intestine, especially in the colon (for example, poorly absorbed transuranium and rare earth elements), to cleanse these parts of the intestinal tract, it is necessary to give siphon and regular enemas, as well as prescribe saline laxatives.

In case of inhalation contamination with radioactive substances, victims are given expectorants and the stomach is washed. When prescribing these procedures, it should be remembered that 50-80% of radionuclides retained in the upper respiratory tract soon enter the stomach as a result of ingestion of sputum. In some cases, it is advisable to inhale in the form of aerosols the use of substances that are capable of binding radioisotopes and forming 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. later after infection. For these purposes, it is recommended to prescribe pentacin (trisodium calcium salt of diethylenetriamine pentaacetic acid), which has the ability to bind radionuclides such as plutonium, transplutonium elements, radioactive isotopes of rare earth elements, zinc and some others into strong non-dissociating complexes.

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

DURING 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, dimethcarb, dixaphen, metaclopramide, diphenidol, atropine, aminazine, aeron, etc.). To prevent nausea and vomiting, take orally tablets of dimethcarb 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. If vomiting develops, dimetpramide is administered intramuscularly at 1 ml of a 2% solution, or dixafen at 1 ml, or aminazine at 1 ml of a 0.5% solution, or atropine at 1 ml of a 0.1% solution subcutaneously. To combat hemodynamic disorders, cordiamine, caffeine, camphor can be used; for collapse - prednisolone, mezatone, norepinephrine, polyglucin; for heart failure - corglycon, strophanthin). For uncontrollable vomiting, diarrhea and dehydration - 10% sodium chloride solution, saline solution.

The basis of early pathogenetic therapy is 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 in cells and tissues of so-called radiotoxins, which, depending on the timing of appearance and chemical nature, are divided into primary and secondary. Primary radiotoxins include products of radiolysis of water, substances of quinoid nature and compounds that appear during the oxidation of lipids (aldehydes, ketones, etc.). Secondary radiotoxins result from the breakdown of radiosensitive tissues; These are mainly the oxidation products of phenolic and hydroaromatic compounds formed in excess quantities. They appear at later stages of the formation of radiation damage as a consequence of deep biochemical changes in metabolism and physiological disorders. Radiotoxins, having high biological activity, can cause breaks in chemical bonds in DNA molecules and interfere with their repair, contribute to the occurrence of chromosomal aberrations, damage the structure of cell membranes, and suppress the processes of cell division.

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 changes in the water-electrolyte balance, currently in the system of combating early post-radiation toxemia, preference is given to detoxifiers - plasma substitutes with hemodynamic, detoxification and multifunctional action. Among the first, in the mechanism of action of which the main role is played by the effect of “diluting” the concentration of toxins and accelerating their elimination, include polyglucin, reopolyglucin and some other drugs based on dextran. The introduction of these drugs not only dilutes the concentration of radiotoxins, but also binds them. Polyvinylpyrrolidone derivatives hemodez (6% solution of PVP), aminodez (a mixture of PVP, amino acids and sorbitol), gluconeodez (a mixture of PVP and glucose), preparations based on low molecular weight polyvinyl alcohol - polyvisolin (a mixture of NSAIDs, glucose, potassium, sodium and magnesium salts), reogluman (10% dextran solution with the addition of 5% mannitol), in addition to the complex-forming effect, also has a pronounced hemodynamic effect, which helps improve blood microcirculation and improve lymphatic drainage, reduce blood viscosity, and inhibit the processes of aggregation of formed elements.

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

The methods of extracorporeal sorption detoxification - hemosorption and plasmapheresis - are very effective. Currently, the positive effect of hemosorption has been confirmed by extensive practice in treating 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 that involves removing a certain volume of plasma from the bloodstream while simultaneously replenishing it with an adequate amount of plasma-substituting fluids. Conducting plasmapheresis in the first 3 days after irradiation, in the mechanisms of therapeutic action of which it is believed that not only the elimination of antigens and autoimmune complexes, decay products of radiosensitive tissues, inflammatory mediators and other “radiotoxins” plays a significant role, but also the improvement of the rheological properties of blood. Unfortunately, extracorporeal detoxification methods are very labor-intensive and therefore can be used mainly at the stage of specialized medical care if the appropriate resources and resources are available.

The development of toxemia and microcirculatory disorders in the first days after irradiation is partly due to the activation of proteolytic enzymes and disseminated intravascular coagulation. To mitigate these disorders, the use of protease inhibitors (contrical, trasylol, gordox, etc.) and direct anticoagulants (heparin) during the first 2-3 days of radiation sickness of degrees III-IY is indicated.

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

The mechanisms of their anti-radiation action are associated with an increase in tissue radioresistance by activating the migration of lymphoid cells into the bone marrow, increasing the number of receptors on immunocompetent cells, enhancing the interaction of macrophages with T- and B-lymphocytes, increasing the proliferation of hematopoietic stem cells, and activating 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. increases. Some high-molecular compounds (polysaccharides, exogenous RNA and DNA) are also capable of sorbing and inactivating radiotoxins.

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

IN THE HIDDEN PERIOD

During the latent period, possible foci of infection are sanitized. Sedatives, antihistamines (phenazepam, diphenhydramine, pipolfen, etc.), vitamin preparations (group B, C, P) may be prescribed. In some cases, with an extremely severe degree of acute radiation sickness from relatively uniform irradiation (dose equal to or more than 6 Gy), if there is such a possibility, on days 5-6, it is possible earlier; after irradiation, a transplantation of allogeneic or syngeneic (previously prepared) from damaged and preserved) bone marrow. Allogeneic bone marrow must be selected according to the ABO group, Rh factor and typed according to the HLA antigen system of leukocytes and lymphocyte MS test. The number of cells in the transplant must be at least 15-20 billion. Transplantation is usually performed 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 the 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 the donor’s without its engraftment.

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

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

Replacement therapy and restoration of hematopoiesis;

Prevention and treatment of hemorrhagic syndrome;

Prevention and therapy infectious complications.

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

Before entering the patient’s room, the staff puts on gauze respirators, an additional gown and shoes placed on a mat moistened with a 1% chloramine solution. Systematic bacterial control of the air and objects in the ward is carried out. Careful oral care and hygienic treatment of the skin with an antiseptic solution are 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 impossible (for example, when there is a mass intake of affected people), it is recommended to carry out a selective determination of antibiotic sensitivity to microorganisms isolated from individual victims.

To treat this group of patients, antibiotics should be used to which the most common pathogenic strain of the microbe is sensitive. If bacteriological control is impossible, 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 (II-III stage) 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. The antibiotics of choice are semisynthetic 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 the indicated antibiotics with ceporin (3-6 g per day) and gentamicin (120-180 mg per day), ampiox, kanamycin (0.5 twice a day), doxycycline, carbenicillin, lincomycin, rifampicin. Replacement is carried out empirically, without taking into account the data of bacteriological studies. If successful, continue administering the drug until agranulocytosis ends - the leukocyte content in the peripheral blood increases to 2.0-3.0x10 9 /l (7-10 days). The emergence of a new focus of inflammation during a given antibiotic regimen requires a change in drugs. If possible, regular bacteriological examination is carried out, and 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), reverine, gentomycin. To prevent superinfection with fungi, nystatin is prescribed 1 million units per day 4-6 times or levorin or amphitericin. For severe staphylococcal lesions of the mucous membrane of the mouth and pharynx, pneumonia, septicemia, anti-staphylococcal plasma or anti-staphylococcal gammaglobulin and other targeted globulins are also indicated. In case of acute radiation sickness of degrees 2 and 3, it is desirable to introduce drugs that increase the nonspecific resistance of the body.

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

For anemia, hemotransfusions of same-group Rh-compatible blood are necessary, preferably red blood cells, erythrocyte suspension, 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 bone marrow depletion and aggravate the course of the disease. To eliminate toxemia, an isotonic solution of sodium chloride, a 5% glucose solution, hemodez, polyglucin and other liquids are injected into a vein by drip, sometimes in combination with diuretics (Lasix, mannitol, etc.), especially with cerebral edema. Doses are controlled by the volume of diuresis and electrolyte composition.

In case of severe oropharyngeal and gastrointestinal syndrome - nutrition through a permanent (anorexia) nasal tube (special nutrition, pureed food), prescribe pepsin, antispasmodics, pancreatin, dermatol, calcium carbonate in standard doses. In case of oropharyngeal syndrome, it is also necessary to treat the oral cavity with antiseptic solutions and preparations that accelerate reparative processes (peach and sea buckthorn oil).

For severe intestinal lesions - parenteral nutrition (protein hydrolysates, fat emulsions, polyamine mixtures), fasting. If necessary, symptomatic therapy: if vascular insufficiency- mezaton, norepinephrine, prednisolone; for heart failure - corglycone or strophanthin.

DURING THE RECOVERY PERIOD, in order to stabilize and restore hematopoiesis and central nervous system function, small doses of anabolic steroids (nerobol, retabolil), tezan, pentoxyl, lithium carbonate, sodium nucleic acid, securinin, bemityl are prescribed; vitamins of group 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 or more, hemostatic (when the number of platelets increases to 60-80 thousand in 1 μl) drugs is canceled, rational psychotherapy is carried out, and he is correctly oriented in work and life mode The time frame for discharge from the hospital does not exceed 2.5-3 months for grade III ARS, 2-2.5 months for grade II ARS, and 1-1.5 months for stage 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 those affected, the prognosis for life, the standard and time capabilities of the stage.

FIRST MEDICAL AID is provided immediately after radiation injury in the form of self- and mutual assistance. The means of preventing the primary reaction are taken orally - dimethcarb, in case of vomiting and physical inactivity - dixafen intramuscularly; when skin and clothing are contaminated with RV - partial sanitization; if there is a danger of further exposure (being on the ground) to contaminated radioactive substances, a radioprotector - cystamine or B-130 - is taken orally.

FIRST CARE is provided by a paramedic or medical instructor. If vomiting and physical inactivity develop, use dimetpramide or dixafen intramuscularly; at cardiovascular failure- cordiamine s.c.; caffeine IM; for psychomotor agitation, take phenazepam; if further stay in the zone is necessary increased radiation orally - cystamine or B-130; if skin or clothing is contaminated with RV - partial sanitization.

FIRST MEDICAL AID is carried out at the medical station. It is of great importance to carry out correctly, quickly and accurately medical triage. At the sorting post, those infected with radioactive substances are identified and sent to the site for partial sanitization (PST). All others, as well as those affected after PSO, are examined by a doctor at the triage site as part of a medical team (doctor, nurse, registrar). Those affected are identified as requiring emergency assistance.

Emergency first aid measures include: in case of severe vomiting - dimetpramide intramuscularly, in case of uncontrollable vomiting - dixafen intramuscular or atropine subcutaneously, in case of severe dehydration - drinking plenty of salted water, saline solution subcutaneously and intravenously ; for acute vascular insufficiency - cordiamine subcutaneously, caffeine intramuscularly or mezaton intramuscularly; for heart failure - corglycone or strophanthin intravenously; for convulsions - phenazepam or barbamyl intramuscularly.

Delayed treatment measures include prescribing oral ampicillin or oxacillin, intramuscular penicillin to febrile patients; if bleeding is severe, EACA or Ambien IM.

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

QUALIFIED MEDICAL CARE. When those affected by ionizing radiation are admitted to the OMEDB, during the process of sorting, victims with contamination of the skin and uniform with radioactive substances in excess of the permissible level are identified. They are sent to the OSO, where complete sanitary treatment is carried out and, if necessary, emergency assistance is provided. In the sorting and evacuation department, the form and severity of ARS and the state of transportability are determined. Non-transportable patients (acute cardiovascular failure, uncontrollable 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, return to their unit. All patients with a more severe degree of ARS (dose more than 2 Gy), with the exception of those with 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 the VPGLR, at stages II-IY. - to therapeutic hospitals.

Emergency qualified medical care measures:

in case of severe primary reaction (persistent vomiting) - dimethpramide or dixafen intramuscularly or atropine subcutaneously, in case of severe dehydration, sodium chloride solutions, hemodez, rheopolyglucin - all intravenously.

for cardiovascular failure - intramuscular mezaton or intravenous norepinephrine with glucose solution, for heart failure - corglikon and strophanthin intravenous drip in glucose solution;

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

for severe infectious complications - ampicillin with oxacillin or rifampicin or penicillin, or erythromycin orally.

Deferred measures of qualified assistance include the appointment of:

when excited - phenazepam, oxylidine orally;

when the number of leukocytes decreases to 1x10 9/l and fever - tetracycline, sulfonamides orally;

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

in the cerebral form of ARS, to relieve suffering - phenazepam intramuscularly, barbamil intramuscularly, promedol subcutaneously.

After providing qualified assistance and preparing for evacuation, ARS patients are evacuated to the hospital base.

SPECIALIZED MEDICAL CARE is provided in therapeutic hospitals. In addition to qualified assistance activities in initial period with ARS II-III stage. Hemosorption can be performed in the latent period in patients at 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 leukemia concentrates and platelet mass obtained by cell separation.

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

With SRP incorporation, in addition to the treatment of ARS, medical care measures are carried out aimed at removing radioactive substances that have entered the body: gastric lavage, prescribing laxatives, adsorbents, cleansing enemas, expectorants, diuretics, administration of complexones (EDTA, pentacin, etc.). For betadermatitis - pain relief (novocaine blockades, local anasthesin), bandages with antibacterial agents, etc.

In case of CRP, it is necessary to combine complex therapy for radiation sickness with the treatment of non-radiation injuries. Surgical treatment must be completed in the latent period of radiation sickness; during the peak period, operations are 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 occurrence of infectious processes and agranulocytosis).

At the height of the disease, special attention is paid to the prevention and treatment of wound infections and the prevention of bleeding from wounds (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 suitability for further service in the Armed Forces.

Associated with exposure to ionizing radiation on the human body.

Causes and symptoms of radiation sickness

According to its occurrence, this disease is divided into both acute, which arose as a result of a single, but exceeding the norm, radiation exposure, and chronic, when radiation affects the human body for a long time regularly or periodically.

The acute form of radiation sickness has several stages.

Let's consider the degrees of radiation sickness:

Grade 1 occurs as a result of irradiation in the amount of 1-2 GR (100-200 rad). Appears after 2-3 weeks.
Grade 2 occurs as a result of exposure to radiation of 2-5 Gy (200-500 rad). Appears on day 4-5.
Grade 3 appears with a radiation dose of 5-10 GR (500-1000 rad). Appears 10-12 hours after irradiation.
Grade 4 occurs with a radiation dose of more than 10 Gy (1000 rad), and appears literally 30 minutes after irradiation. This dose of radiation is absolutely lethal.

Radiation doses up to 1 Gy (100 rad) are considered mild and cause conditions that medical practice are called pre-disease.

When exposed to radiation above 10 Gy, the first symptoms appear within a couple of hours. Redness of the skin is observed in places where the most intense irradiation occurred. Nausea and vomiting occur.

With large doses of radiation, there may be disorientation, and. Cell death in the gastrointestinal tract occurs.

Over time, symptoms progress - atrophy of mucosal cells occurs and bacterial infections. The cells that absorbed nutrients are destroyed. This often causes bleeding.

A radiation dose of more than 10 Gy is lethal for humans. Death usually occurs within 2 weeks.

If infectious complications occur, large doses are used antibacterial drugs. Severe radiation sickness sometimes requires a bone transplant. But this method It does not always help, since tissue incompatibility is often observed.

When coming into contact with contaminated objects, all parts of the body must be shielded. It is mandatory to take medications that can reduce the level of sensitivity to radioactive radiation.

One of the most effective methods prevention is considered to be the use of radioprotectors. These elements are protective compounds, but can cause others.

When exposed to human body ionizing rays in large doses can cause radiation sickness - damage to cellular structures, tissues and liquid environments, occurring in acute or chronic form. In our time acute illness is relatively rare - this is only possible in accidents and a single high-power external exposure. Chronic radiation pathology is caused by prolonged exposure to the body of a radiation flux in small doses, however, exceeding the maximum permissible quantity. In this case, almost all organs and systems are affected, so the clinical picture of the disease is varied and not always the same.

ICD 10 code

J 70.0 – Acute pulmonary pathology provoked by radiation.
J 70.1 – Chronic and other pulmonary pathologies provoked by radiation.
K 52.0 – Radiation form of gastroenteritis and colitis.
K 62.7 – Radiation form of proctitis.
M 96.2 – Post-radiation form of kyphosis.
M 96.5 – Post-radiation form of scoliosis.
L 58 – Radiation dermatitis.
L 59 – Other dermatological diseases associated with exposure to radiation.
T 66 – Unspecified pathologies associated with radiation.

ICD-10 code

Z57.1 Adverse effects of occupational radiation

Causes of radiation sickness

An acute form of radiation sickness in humans occurs with short-term (several minutes, hours, or 1-2 days) irradiation of the body at a dosage above 1 g (100 Rad.). Such exposure can be obtained while in the area of radiation exposure or during radioactive fallout, when malfunction with strong sources of radiation, during accidents involving the release of radiation, as well as when using radiation therapy for therapeutic purposes.

In addition, the causes of radiation sickness can be Various types radiation and radiation that are in the atmosphere, in consumed food, in water. Radioactive components can enter the body during breathing or when eating. Substances can be absorbed through the pores of the skin, penetrate into the eyes, etc.

Biogeochemical anomalies and pollution play a major role in the occurrence of the disease. environment due to a nuclear explosion, leakage of nuclear waste, etc. During a nuclear explosion, the atmosphere is saturated as a result of the release of radioactive substances into the air that have not entered into chain reaction, causing the appearance of new isotopes. Clearly defined severe course radiation injury noted after explosions or accidents at nuclear or power plants.

Pathogenesis

Radiation sickness can occur acutely (subacutely) or in a chronic form, which depends on the duration and magnitude of the training exposure, which determines the course of the changes that occur. The characteristic etiology of the appearance of the pathology is that the acute form cannot become chronic or, conversely, unlike other diseases.

The appearance of certain signs of the disease directly depends on the dosage of the external radiation load received. In addition, the type of radiation is also important, because each of them has certain characteristics, including the strength of the damaging effect on the body.

For example, α-rays have a high ionization density and low penetrating property, which is why sources of such radiation have a small spatial damaging effect.

ß-rays, with low penetration and low ionization density, affect tissue in areas of the body that are directly adjacent to the radiation source.

At the same time, γ-rays and X-rays lead to deep damage to tissues that come under their influence.

Neutron rays affect organs unevenly because their penetrating properties, as well as linear energy loss, can be different.

Symptoms of radiation sickness

Symptomatic manifestations of radiation sickness can be divided into several degrees of severity, which is explained by the dosage of the radiation received:

when exposed to 1-2 Gy they talk about mild damage;
when exposed to 2-4 Gy – o medium degree;
when exposed to 4-6 Gy - severe damage;
when exposed to radiation of more than 6 Gy - an extremely severe injury.

Clinical signs largely depend on the severity of the damage to the body.

Diagnosis of radiation sickness

When diagnosing a patient with body irradiation, it is first necessary to find out the dosage of rays to which the victim was exposed. Depending on this, further activities will subsequently be determined.

It is necessary to obtain information from the patient or his relatives about the source of radiation, the distance between him and the victim, the duration of exposure, etc.
It is important to learn about the type of rays that affected the person.
The clinical picture, intensity and severity of symptoms are carefully studied.
Blood tests are carried out, preferably again within several days.
A dosimeter, a special device that measures the amount of radiation absorbed, can provide important information.

Blood tests can provide the following information:

With light irradiation (1-2 Gy):

lymphocytes – more than 20%;
leukocytes – more than 3000;
platelets - more than 80,000 in 1 μl.

With average irradiation (2-4 Gy):

lymphocytes – 6-20%;
leukocytes – 2000-3000;

For severe radiation (4-6 Gy):

lymphocytes – 2-5%;
leukocytes – 1000-2000;
platelets – less than 80,000 in 1 µl.

For extremely severe radiation exposure (more than 6 Gy):

lymphocytes – 0.5-1.5%;
leukocytes – less than 1000;
platelets – less than 80,000 in 1 µl.

Additionally, auxiliary research methods may be prescribed that are not fundamental, but are of some value for clarifying the diagnosis.

Laboratory diagnostic methods ( microscopic examination scraping of ulcerative and mucous surfaces, analysis of blood sterility).
Instrumental diagnostics (electroencephalography, cardiography, ultrasonography abdominal cavity, thyroid gland).
Consultation with doctors of narrow specializations (neurologist, hematologist, gastroenterologist, endocrinologist).

If necessary, differential diagnosis is carried out, although if there is reliable data on the fact of exposure, this point is often skipped.

The scheme for calculating the dose load using biological indicators in patients after exposure to ionizing radiation is called the term “biological dosimetry”. In this case, it is not the total volume of emitted energy that was absorbed by the body that is calculated, but the ratio of biological disorders to the dose of short-term one-time exposure. This technique helps to assess the severity of the pathology.

Treatment of radiation sickness

In the case of acute radiation injury, the victim is placed in a special box where appropriate aseptic conditions are maintained. Bed rest is prescribed.

First of all, measures such as treating wound surfaces, cleaning the stomach and intestines, eliminating vomiting, and normalizing blood pressure are taken.

If the exposure is of internal origin, then certain drugs, the action of which is aimed at neutralizing radioactive substances.

At first, strong detoxification therapy is carried out, which includes intravenous administration of saline or plasma-substituting solution, hemodesis, as well as forced diuresis. If the gastrointestinal tract is affected in the first few days, dietary restrictions are prescribed (switching to parenteral nutrition is possible), treatment oral cavity antiseptic liquids.

To eliminate hemorrhages, blood products, platelets or red blood cells are administered. Blood and plasma transfusions are possible.

For warning infectious diseases use antibacterial drugs.

For chronic radiation injury, symptomatic therapy is prescribed.

First aid for radiation sickness is carried out in stages.

The victim must be subjected to preliminary treatment: remove him from clothes, wash him in the shower, be sure to rinse his mouth and nasal cavity, and wash his eyes. 2.
Next, you should perform gastric lavage and, if necessary, give an antiemetic drug (for example, cerucal). 3.
After this, the doctor prescribes anti-shock and detoxification therapy, cardiac and sedative medications.

In the first phase of the disease, medications are prescribed to eliminate attacks of nausea and vomiting. For uncontrollable vomiting, use 0.5 ml of a 0.1% atropine solution subcutaneously or intramuscularly. Can be applied drip administration 50-100 ml hypertonic solution sodium chloride. Severe course Radiation sickness may require detoxification treatment. To prevent a collaptoid state, medications such as norepinephrine, contrical, cordiamine, trasylol or mezaton are prescribed. The skin and accessible mucous membranes are treated with antiseptic solutions. Excessively active intestinal microflora is suppressed by taking indigestible antibacterial drugs, such as gentamicin, neomycin, ristomycin, in combination with antifungal therapy.

When an infection develops, intravenous administration of large doses of antibiotics is used - ceporin, methicillin, kanamycin. Often this treatment is supplemented with biological products - antistaphylococcal, hyperimmune or antipseudomonas plasma. As a rule, antibacterial agents exhibit their effect within 2 days. If positive effect does not occur, then the drug is replaced with another, stronger one.

In case of extremely severe damage with suppressed immunity and decreased hematopoietic function, a bone marrow transplant is performed. The transplanted material is taken from the donor, and the transplant itself is carried out after a course of immunosuppressants (to prevent rejection).

Traditional treatment

Traditional methods used to eliminate signs of radiation sickness include the use garlic tincture, nettle leaves, berries chokeberry, eleutherococcus, sea buckthorn berries, ginseng, coconut, rose hips, grape and currant leaves, quince, seaweed, bee products, red wine. To improve blood composition, plants such as knotweed, dandelion leaves, burdock, and yarrow are used.

Mix 500 ml of red wine (preferably Cahors) with 500 ml of juice from the lower leaves of aloe, 500 g of flower honey and 200 g of ground calamus rhizome. Leave the mixture in the refrigerator for 2 weeks, then consume 1 tbsp. l. 1 hour before meals three times a day, washed down with milk.
600 ml water and 3 tbsp. l. Boil dry raw oregano and leave overnight (you can use a thermos). In the morning, filter and drink 1/3-1/2 cup three times a day. You are allowed to add a spoonful of honey. The duration of treatment depends on the patient's condition and can continue until there are persistent signs of improvement.
1 tbsp. l. mix chagi with 200 ml of boiling water, leave for 15 minutes, then add baking soda on the tip of a knife and leave for 10 minutes. Take the medicine three times a day, 1 tbsp. l. half an hour before meals.
Pour 1 cup of flax seeds into two liters of boiling water and cook for about 2 hours. Remove from heat and cool. Take 100 ml up to 7 times a day.
2 tbsp. l. Boil lingonberry berries for 10 minutes in 500 ml of water, then leave for 1 hour under the lid. Take 250 ml twice a day after meals.

Herbal treatment cannot be done on its own. Such treatment should only be combined with traditional drug therapy prescribed by a medical specialist.

Homeopathy for radiation sickness

The effectiveness of homeopathic medicines in the treatment of radiation sickness has not yet been thoroughly proven. However, American scientists continue to experiment, looking for ways to protect people from harmful radiation.

One of the drugs that has successfully withstood all research and testing is the food supplement Fucus vesiculosus. This drug blocks the absorption of radioactive rays by the thyroid gland, preventing its receptors from performing their function. This dietary supplement is made from seaweed.

A remedy such as Cadmium sulphuratum also has a similar effect. Among other things, this drug significantly alleviates the symptoms of radiation sickness, such as itchy skin, dyspeptic disorders, muscle pain.

However, it should be taken into account that there is no direct evidence of the effectiveness of these drugs yet, so the decision to use them is quite risky. Before you start taking homeopathic remedies, consult your doctor.

Prevention and prognosis of radiation sickness

The calculation of the prognosis of radiation sickness directly depends on the amount of radiation exposure received and the duration of its exposure. Victims who survived critical period(which is 3 months) after radiation injury, have every chance of a favorable outcome. But even in the absence of mortality, patients may have some health problems in the future. Blood diseases and malignant tumors can develop in almost any organs and tissues, and the next generation has high risk development of genetic disorders.

Preventive measures aimed against radiation injury may involve installing protective elements on the torso or individual parts of the body (so-called shields). Employees of hazardous enterprises undergo certain training and wear special clothing. Also, people at risk may be prescribed drugs that reduce the sensitivity of tissues to radioactive rays. It is mandatory to take vitamins B, as well as C and P.

People who have regular contact with sources of radiation should periodically visit preventive examinations and take a blood test.

Radiation sickness is a difficult disease that cannot be cured on your own. And it’s hardly worth the risk, because the consequences of such a pathology are very serious. Therefore, if there is any suspicion of radiation exposure, even if there are no symptoms of damage, you must consult a doctor and undergo the necessary examinations.

Radiation sickness is the body's reaction to the effects of radioactive radiation. Under its influence, unnatural processes are launched in the body, which lead to failures in many body systems.

The disease is considered very dangerous because it provokes irreversible processes. Modern medicine can only stop their destructive development in the body.

The degree of radiation damage depends on the area of the irradiated body surface, the time of exposure, the method of penetration of radiation, and also on the body’s immune response.

There are several forms of the disease: those that are formed as a result of uniform irradiation, as well as with narrowly localized effects of radiation on certain part body or organ. In addition, there are transitional and combined forms of the disease, in acute and chronic course.

Penetrating radiation provokes oxidative reactions in cells. This depletes the system antioxidant protection, and the cells die. This leads to a gross disruption of metabolic processes.

Considering the degree of radiation damage, it is possible to determine the main systems that are most susceptible to pathological effects. The gastrointestinal tract, circulatory and central systems are primarily affected. nervous system, spinal cord. By affecting these organs and systems, radiation causes serious dysfunction. The latter can manifest themselves as single complications or in combination with others. At complex symptoms Usually they talk about third degree radiation damage. Such pathologies usually end in death.

Radiation sickness can occur in acute and chronic forms, depending on absolute value radiation load and duration of its exposure. The unique mechanism for the development of acute and chronic forms of the disease excludes the possibility of transition from one form of the disease to another.

The conditional boundary that separates acute form from chronic - this is the accumulation over a limited period (1 hour - 3 days) of a total tissue dose of radiation, which is equivalent to the effect of 1 Gy of external penetrating radiation.

The type of radiation also plays an important role in the development of radiation sickness. Each of them has its own characteristics of defeat various organs and systems. Let's take a closer look:

Alpha radiation. It is characterized by high ionization density and low penetrating ability. Therefore, sources emitting a-waves have a spatially limited damaging effect.
Beta radiation. Has weak penetrating and ionizing ability. Can affect tissue directly in areas of the body that are closely adjacent to the radiation source.
Gamma rays and x-rays. Causes deep damage to all tissues in the area of the radiation source.
Neutron radiation. It has different penetrating abilities, so it affects organs heterogeneously.

In the case of irradiation with a dose of 50-100 Gy, damage to the central nervous system plays a major role in the development of the disease. In this case, death is usually observed 4-8 days after radiation damage.

When irradiated with a dosage of 10-50 Gy, symptoms of damage to the digestive organs come to the fore. In this case, mucosal rejection occurs small intestine, and death occurs within 14 days.

At lower doses of radiation (1-10 Gy) observed, first of all, hematological syndromes, bleeding, complications of infectious origin.

Main causes of radiation sickness

The development of the disease can be caused by external and internal radiation. Radiation can enter the body through inhaled air, through the skin, gastrointestinal tract, mucous membranes, and also as a result of injections.

Small doses of ionizing radiation from various sources (natural and man-made) constantly affect humans. But at the same time, the development of radiation sickness does not occur. It occurs in humans under the influence of radioactive radiation received in a dosage of 1-10 Gy or higher. With lower doses of radiation (0.1-1 Gy), preclinical manifestations of the disease may occur.

There are two main causes of radiation sickness:

Single (short-term) irradiation high level during various man-made disasters in nuclear power, conducting experiments, using nuclear weapons, treating oncological and hematological diseases.
Long-term training with small doses of radiation. Typically observed among health care workers in radiation therapy and diagnostic departments (radiology, x-ray), as well as patients who require regular radionuclide and x-ray examinations.

Symptoms of radiation sickness

The symptoms of the disease depend, first of all, on the dose of radiation received, as well as on the severity of the disease. There are several main phases of radiation sickness, which are characterized by certain symptoms:

The first phase is the primary general reaction. It is observed in all people who have received radiation dosages above 2 Gy. The manifestation period depends on the radiation dose and, as a rule, is calculated in minutes and hours. Characteristic signs: nausea, vomiting, feeling of bitterness and dry mouth, weakness, fatigue, headache, drowsiness. A state of shock often occurs, which is accompanied by a drop in blood pressure, loss of consciousness, fever, and diarrhea. Such symptoms of radiation sickness usually appear when exposed to a dose of more than 10 Gy. Sometimes redness of the skin with a bluish tint appears in areas of the body that have been irradiated with a dose of 6-10 Gy. Patients may experience variability in pulse and pressure with a tendency to decrease, general muscle tone and tendon reflexes decrease, and fingers tremble. Developed inhibition of the cerebral cortex also appears. During the first day, the number of lymphocytes in the blood decreases in patients. This process is associated with cell death.
The second phase is hidden or latent, in which clinical well-being is noted. Usually occurs after the symptoms of the primary reaction disappear 3-4 days after radiation damage. Can last up to 32 days. The patients' well-being improves significantly; only some instability in pulse rate and blood pressure levels may persist. If the dose of radiation received was more than 10 Gy, then this phase may be absent and the first flows into the third. On days 12-16, patients who have received more than three Grays of radiation begin to experience baldness. Also during this period there may be various lesions skin. Their prognosis is unfavorable and indicates a high dose of radiation. In the second phase, neurological symptoms may become clear: movements are impaired, trembling eyeballs, decreased reflexes, mild pyramidal insufficiency. By the end of the second phase, blood clotting slows down and the stability of the vascular wall decreases.
Third phase - bright severe symptoms . The timing of onset and intensity of symptoms depend on the dose of ionizing radiation received. The duration of the period ranges from 7-20 days. Damage to the circulatory system, suppression of the immune system, hemorrhagic syndrome, development of infections, and autointoxication come to the fore. By the beginning of this phase, the patient’s condition deteriorates greatly: weakness increases, a rapid pulse and fever are noted, and blood pressure decreases. The gums begin to bleed and swelling appears. The mucous membranes of the oral cavity and digestive organs are also affected, and necrotic ulcers appear. With a small dose of radiation, the mucous membrane is restored almost completely over time. With a large dose of radiation, inflammation of the small intestine occurs. It is characterized by diarrhea, bloating, soreness in iliac region. In the second month of radiation sickness, inflammation of the esophagus and stomach often occurs. Infections, as a rule, manifest themselves in the form of sore throats of an erosive and ulcerative nature, pneumonia. Hematopoiesis is inhibited and the immunobiological reactivity of the body is suppressed. Hemorrhagic syndrome manifests itself in the form of numerous hemorrhages that appear in various places, such as skin, heart muscle, digestive organs, central nervous system, respiratory mucosa, urinary tract. Extensive bleeding is usually observed. Neurological symptoms manifest themselves in the form of general weakness, adynamia, decreased muscle tone, blackouts, growth of tendon reflexes, meningeal manifestations. Signs of increasing edema of the brain and membranes are often detected.
The fourth phase is the period of restoration of structure and functions. The patients' condition improves, hemorrhagic manifestations disappear, damaged areas of the skin and mucous membranes begin to heal, and new hair grows. Recovery period usually lasts about six months. With large doses of radiation, recovery can take up to two years. After the end of the fourth phase, we can talk about full recovery. True, in most cases, after irradiation and radiation sickness, residual manifestations remain. The healing process is accompanied by disruptions heart rate, surges in blood pressure.

Radiation sickness often causes complications such as eye cataracts, leukemia, and neuroses of various types.

Classification of radiation sickness

The classification of the disease is based on the criteria for the duration of the lesion and the dosage of ionizing radiation. With a single massive exposure to radiation, acute radiation sickness develops. Long-term, repeated exposure to relatively small doses results in a chronic disease.

The degree of radiation sickness and the clinical form of damage are determined by the dosage of radiation received:

Radiation injury. It can occur with short-term, simultaneous exposure to radiation with a dosage of less than 1 Gy. Pathological disorders are reversible.
Bone marrow form (typical). Develops with short-term simultaneous irradiation of 1-6 Gy. The mortality rate is 50%. It can have four degrees: mild (1-2 Gy), moderate (2-4 Gy), severe (4-6 Gy), extremely severe (6-10 Gy).
Gastrointestinal form. The result of one-time short-term exposure to radiation of 10-20 Gy. Characterized by severe enteritis, hemorrhagic syndrome, fever, infectious and septic complications.
Vascular (toxemic) form. The result of simultaneous irradiation with a dose of 20-80 Gy. Hemodynamic disturbances and severe intoxication are noted.
Cerebral form. Develops as a result of exposure to a dose of more than 80 Gy. Death occurs on the first or third day. The cause of death is cerebral edema.

Chronic radiation sickness occurs in three periods: formation, recovery, consequences (outcome, complications). The period of formation of pathologies lasts about 1-3 years. At this time, the clinical syndrome develops varying degrees gravity. The recovery period usually begins after the intensity of radiation has decreased or the radiation exposure has completely stopped.

The outcome of chronic radiation sickness may be recovery, partial restoration, stabilization of favorable changes or their progression.

Features of treatment of radiation sickness

When exposed to radiation with a dose higher than 2.5 Gy, fatal outcomes are possible. A dose of 4 Gy is considered average lethal for humans. Clinical recovery is possible with correct and timely treatment radiation sickness with irradiation of 5-10 Gy. However, in the vast majority of cases, exposure to a dose of 6 Gy is fatal.

Treatment of the disease consists of ensuring an aseptic regime in specially equipped wards, preventing infectious complications and relieving symptoms. When fever and agranulocytosis increase, antibiotics and antiviral drugs are used.

To relieve nausea and vomiting, Aeron, Aminazine, and Atropine are prescribed. In case of dehydration, saline solution is infused.

In case of severe radiation, detoxification therapy is carried out during the first day with Cordiamine, Mezaton, Norepinephrine, and kinin inhibitors.

To enhance anti-infective therapy, hyperimmune plasma and gamma globulin are prescribed. A system of measures aimed at preventing internal and external infections uses isolators different types with the supply of sterile air, sterile materials, food. Skin and mucous membranes should be treated with antiseptics. To suppress the activity of intestinal flora, non-absorbable antibiotics are used - Gentamicin, Kanamycin, Neomycin, Ristomycin.

Replacement of platelet deficiency is carried out by introducing platelet mass obtained from one donor after irradiation with a dose of 15 Gy. According to indications, transfusions of washed fresh red blood cells may be prescribed.

To combat bleeding, general and general hemostatic drugs are used. local action. Medicines that strengthen the vascular wall are also prescribed - Dicinon, Rutin, ascorbic acid, steroid hormones, and also increase blood clotting - Fibrinogen.

Local damage to the mucous membrane requires special care and treatment with bactericidal mucolytic drugs. To eliminate skin lesions, aerosols and collagen films, moisturizing dressings with antiseptics and tannins, as well as ointment dressings with hydrocortisone and its derivatives are used. Unhealed wounds and the ulcers are excised with further plastic surgery.

With the development of necrotic enteropathy, Biseptol, antibiotics that sterilize the gastrointestinal tract, are used. Complete fasting is also indicated. The use of boiled water and anti-diarrhea medications is allowed. In particularly severe cases, parenteral nutrition is used.

At high doses radiation, the absence of contraindications and the presence of a suitable donor, bone marrow transplantation is recommended. Usually the indication is irreversible depression of hematopoiesis, deep suppression of immunological reactivity.

Consequences and complications of radiation sickness

The prognosis of the disease is related to the massiveness of the radiation dose and the duration of exposure. Patients who survive the critical period of 12 weeks after radiation have a chance of a favorable outcome.

However, even after non-fatal radiation injury, victims may often subsequently develop various complications- hemoblastoses, malignant formations of different localization. Loss of reproductive function often occurs, and various genetic abnormalities may be detected in the offspring.

Latent chronic symptoms may also become aggravated. infectious diseases, blood pathologies. Deviations also occur in the field of ophthalmology - the lens and vitreous body become cloudy. Various degenerative processes occur in the body.

Maximum protection from the consequences of radiation sickness is possible only with timely access to a specialized clinic.

How to treat radiation sickness- look at the video:

Radiation sickness is a serious illness manifested by a whole “bouquet” of symptoms. Effective treatment The disease does not currently exist, and therapy is limited to suppressing symptoms. Therefore, it is important to take precautions near radiation sources and try to protect yourself as much as possible from ionizing radiation.