BACKGROUND Irradiation: definitions Acute localised radiation syndrome, or radiological burn, results from exposure of a part of the body to a not-too-distant source of radiation (chiefly X-rays, gamma rays and neutrons) or the deposition of radioactive particles on the skin (chiefly beta emitters). Clinical presentation INITIAL PHASE The initial symptomatology only exists for very high doses to the skin. Intense and early onset of these symptoms is always a sign of severity: • initial sensation of heat; • dysesthesia (“pins and needles” sensation) and immediate pains; • erythema, early oedema. LATENT PERIOD Depending on the case, the initial phase is followed by a latent period whose duration is inversely proportional to the severity of the irradiation. MANIFEST PHASE The following will appear successively depending on the dose to the skin: • cutaneous erythema (4 to 5 Gy), • dry dermatitis, loss of hair (5 to 12 Gy), • exudative dermatitis, blister (12 to 20 Gy), • necrosis (> 25 Gy). The dosed indicated must be considered as rough estimates. DEVELOPMENT This syndrome is characterised by a dynamic development that is difficult to predict, as much in the kinetics of the extension or regression of the symptoms as in its extent in surface area and depth (surgical treatment is difficult). Inflammation flare-ups and resurgence of necrosis are sometimes observed several years after the accident. The pain is intense, permanent, resistant to opioids, but often sensitive to non-steroidal anti-inflammatories. EXAMINATIONS The symptoms settle in gradually over time. If paraclinical examinations are indicated, they must be carried out as from the initial phase to allow an early diagnosis (magnetic resonance imaging – MRI and ultrasound scan). The recommendations of the experts of the Institute of Radiation Protection and Nuclear Safety (IRSN) and of the radiopathology experts enable the prescription of these examinations to be adjusted according to the lesional appearance and the dosimetric evaluation, which must be carried out concomitantly. SEE SHEET 12 Acute localised radiation syndrome 11 SHEET 42 MEDICAL RESPONSE IN NUCLEAR OR RADIOLOGICAL EMERGENCY
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