Immediate First Aid/ Ensure that adequate decontamination has been carried out as needed. If patient is not breathing, start artificial respiration, preferably with a demand valve resuscitator, bag-valve-mask device, or pocket mask, as trained. Perform CPR if necessary. Immediately flush contaminated eyes with gently flowing water. Do not induce vomiting. If vomiting occurs, lean patient forward or place on left side (Head-down position, if possible) to maintain an open airway and prevent aspiration. Keep patient quiet and maintain normal body temperature. Obtain medical attention. /Radiological Threats: Radiological Dispersal Devices or Weapons/
Basic Treatment. Establish a patent airway (oropharyngeal or nasopharyngeal airway, if needed). Suction if necessary. Watch for signs of respiratory insufficiency and assist ventilations if necessary. Administer oxygen by nonrebreather mask at 10 to 15 mL/min. Monitor for shock and treat if necessary. Anticipate seizures and treat if necessary. Perform routine emergency care for associated injuries. ... Perform routine basic life support care as necessary. /Radioactives I, II, and III/
Basic Treatment. Establish a patent airway (oropharyngeal or nasopharyngeal airway, if needed). Watch for signs of respiratory insufficiency and assist ventilations if necessary. Administer oxygen by nonrebreather mask at 10 to 15 L/min. Monitor for shock and treat if necessary. Anticipate seizures and treat if necessary. Perform routine emergency care for associated injuries. For eye contamination, flush eyes immediately with water. Irrigate each eye continuously during transport. Do not use emetics. For ingestion, rinse mouth and administer 5 mL/kg up to 200 mL of water for dilution if the patient can swallow, has a good gag reflex, and does not drool. Perform routine BLS care as necessary. /Radiological Threats: Radiological Dispersal Devices or Weapons/
Advanced Treatment. Consider orotracheal or nasotracheal intubation for airway control in the patient who is unconscious or is in severe respiratory distress. Monitor cardiac rhythm and treat arrhythmias as necessary. Start IV administration of 0.9% saline (NS) or lactated Ringer's (LR) TKO. For hypotension with signs of hypovolemia, administer fluid cautiously. Watch for signs of fluid overload. Treat seizures with diazepam or lorazepam. Perform routine advanced life support care as needed. Use proparacaine hydrochloride to assist eye irrigation. /Radioactives I, II, and III/
/CASE REPORTS/ /SKIN/ A 32-year-old industrial radiographer presented with skin changes involving the distal aspects of the first three digits of both hands. There was deformity of the left distal third digit and ulceration of the distal second digit. The patient had been an industrial radiographer for approximately 10 years. Approximately 2 years prior to presentation, the patient had knowingly handled an industrial radiography camera in which the 3.1x10+12 Bq (85 Ci) iridium-192 source had become disconnected from the cable and remained in the source tube. ... He noted erythema and blistering of the first three digits of the left hand 2 to 4 weeks post-exposure. His fingernails came off 4 to 5 weeks post-exposure. ... Healing occurred over the next 1 to 3 months. Approximately 18 months after exposure, the distal second digit become ulcerated and did not heal over the next 6 months. ... The ulceration was clearly visible as were skin thinning and loss of the normal fingerprint pattern. A radiograph of the hand revealed a lytic destructive lesion of the bone in the distal phalanx. Three-phase radionuclide bone scanning was performed and demonstrated little blood flow to the area. As a result, amputation of the distal phalanx was performed and pathological examination revealed both osteonecrosis as a result of radiation injury and concurrent osteomyelitis. The lesion healed satisfactorily after surgery. /Iridium-192/
Inhalation of Metallic Iridium-192:r ... Two employees ... accidentally inhaled insoluble particles of iridium-192 ... and were kept under periodic examination for 2 years ... . The inhalation incident occurred ... when a hot cell technician, seeking to open a capsule containing 2,000 Ci of iridium-192 pellets, accidentally cut into eight of the pellets. ... As a result of the loss of negative pressure within the cell, about 2 Ci escaped... The iridium was apparently inhaled as submicron-sized particles of metal, with perhaps some oxide ... They went to lunch ... without knowing about their exposure. They returned to the plant about 2 hours after the exposure and then checked their hands on a beta-gamma monitor. ... The employees were decontaminated at the plant and were sent to the University of Pittsburgh whole-body counter about 8 hr after the initial exposure... . Measurements with portable scintillation-counter and GM-counter survey meters, at about arm's length, immediately indicated that one of the employees had an internal total body burden on the order of 1 to 2 mCi, and that his coworker had about one-third of this burden. ... Calculations of possible GI tract and lung doses ... indicated that serious exposures might be incurred. All fecal and urinary excreta of the two higher-exposed individuals ... were collected and the individuals were hospitalized for several days for further medical diagnosis and body burden evaluation. No chelation therapy was administered since none of the known therapeutic agents was expected to be effective against iridium metal... . External measurements with portable survey instruments already indicated at 10 hr postexposure that a considerable fraction of the inhaled material had entered the stomach and low portions of the gastrointestinal tract. ... The decrease of lung burden in these cases followed closely the 74.2-d half-life of iridium-192 for many weeks. The lung scans over several weeks showed a pattern typical of a uniform distribution of these submicron iridium particles throughout the lung alveoli for the several weeks over which the scans were taken. This information together with material balances from fecal and in vivo measurements, showed that the lung retention of the two patients after 24 hr was 6 and 13%, respectively, of the initially inhaled amount, the remainder exhaled or cleared through the fecal route with no urinary excretion ... . Long-term measurements, as indicated above, showed no biological removal of iridium from the lung after initial mucociliary clearance and no measurable 192-Ir in the urine, despite the large initial depositions in both cases. (Measurements of urine ... showed that there was less than 1X10-4 uCi excreted in urine per day, which was less than one-millionth of the remaining lung burden per day. Statistical interpretation of the long-term data indicated that the biological half-life of metallic iridium in the lung, even as submicron particles, was at least as great as about 700 d, and possibly infinite.
