In a hypothetical radiological accident in the nuclear weapons industry, a worke

Question

In a hypothetical radiological accident in the nuclear weapons industry, a worker receives doses to specific parts of her anatomy of the order 10,000 Gy. The patient is observed to survive the accident - with proper medical care - for many months. Given that a lethal whole body dose is about 4 Gy, how can you explain this patient's survival given that her dose is about 1000 times higher than the lethal dose? Explain in 4 - 5 sentences. Parts of her skin received a dose of 4.5 Gy. What clinical effects can you expect in this area of the skin? Explain in 2 - 3 sentences. Another part of her skin received a dose of 45 Gy. What clinical effects do you expect to observe in these areas? Explain in 2 - 3 sentences.

Explanation / Answer

(a) When a patient is exposed to higher dose of ionizing radiations (nore than the lethal dose), the chances of survival becomes less than 5 %. These ionizing radiations have both immediate as well as delayed effects, wherein death occurs within 48 hours. Person immediately feels nausea and vomiting, headaches, fatigue, and fever, blood cells begin to die, there could be uncontrollable bleeding due to a lack of platelets, and anemia due to a reduction of red blood cells along with neurological damage. In the present case, the paient has survived even after exposure of 1000 times higher than the lethal dose because she might have received an immediate medical aid. Treatment in such cases include blood transfusions and use antibiotics for established or suspected infection, as the immune system is weeked after exposure. Anti-micronial therapy, that might go on for long duration in such case improvise gastrointestinal tract, lungs and central nervous system. Antimicrobials should be directed more for the eradication of Gram-negative aerobic bacilli, as they are the leading cause of sepsis.

(b) Parts of the patient's skin that was exposed to radiation of 4.5Gy or more would have a transient and inconsistent redness along with itching within few hours of exposure. I few days of time, intense reddeness, blistering, and ulceration of the irradiated site are visible. this is refered to as cutaneous radiation syndrome. In most cases, healing occurs naturally with time through regenerative means.

(c) Exposed areas of patient's skin which received the exposure of 45 Gy, may suffer from permanent hair loss, damaged sebaceous and sweat glands, atrophy, fibrosis (mostly Keloids), decreased or increased skin pigmentation, and ulceration or necrosis of the exposed tissue.  Moist desquamation or peeling of skin may occur which may eventually result in  damaged dermal vascular system, resulting in loss of full thickness of exposed skin.

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