(p. 1573) Management of radiation poisoning 

In radiation poisoning, a distinction between exposure and contamination should be made. Decontamination by removing clothes, washing of skin, and removal of debris can remove up to 90% of external contaminated radiation. Treatment of acute life-threatening injuries takes priority over treatment of radiation poisoning. Triage of severely exposed patients can give an indication of dose and severity of the radiation dose absorbed. Survival is related to dose absorbed. Identification of the radiation source should be made by the radiation characteristics to determine the shielding necessary for protection of hospital staff and the antidote required. Early gastric lavage and specific antidotes for ingested radiation poisoning should be used with caution. Death is mainly due to infection and haemorrhage. Acute radiation syndrome (ARS) is a manifestation of haematopoietic, gastrointestinal, cardiovascular, central nervous system, and cutaneous syndromes. Those receiving whole body doses of 1–5 Gy may recover easily with appropriate medical management; those with doses of 6–10 Gy may survive with intensive management; and those with doses of >10 Gy seldom survive. Treatment of ARS is supportive with the use of antibiotics, colony-stimulating factors, blood products, and stem cell transplants. Protection of the staff is by reducing time exposed, increasing distance from source and proper shielding. Psychological counselling should be available to patient or staff if required.