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UKRAINIAN MINISTRY OF HEALTH CARE

State medical university of ukraine

“UKRAINIAN ACADEMY OF MEDICINE AND DENTISTRY”

Emergency medicine

.

EDUCATIONAL MATERIAL FOR INDEPENDENT STUDY

FOR FOUR GRAD DENTAL FACULTY STUDENTS

Poltava, 2008

Contents

Contributors Preface Lesson 1,2 RADIATION EMERGENCY Lesson 3. CHEMICAL VEAPON Lesson 4. POISONING Lesson 5. CARDIOLOGY EMERGENCY Lesson 6. PULMONOLOGY EMERGENCY Lesson 7. GASTROENTEROLOGY EMERGENCY Lesson 8. NEPHROLOGY EMERGENCY Lesson 9. HEMATOLOGY EMERGENCY Lesson 10. ENDOCRINOLOGY EMERGENCY Lesson 11. ALLERGOLOGY AND IMMUNOLOGY EMERGENCY Literature

2 3 4 10 22 41 74 85 95 108 131 139

Contributors:

Igor p. Kajdashev m.D., Ph. D, Professor

Head of the Department of Internal Medicine,

UKRAINIAN ACADEMY OF MEDICINE AND DENTISTRY

Michael S. Rasin M.D., Ph. D., Professor

Professor of the Department of Internal Medicine

UKRAINIAN ACADEMY OF MEDICINE AND DENTISTRY

Preface

Beginning students of medicine and dentistry must acquire a set of skills that prepare them to become cli­nicians. This includes establishing rapport and a therapeutic relationship with the patient, basic interviewing, the specific conduct and content of medical data collection (the history and the physical examination), formulation of a problem list and diagnostic hypotheses, documenta­tion and record-keeping, and communication with others involved in the patient's care. An introduction to these skills during the first years of medical school focuses on the basics of data collection and information synthesis rather than the specifics of disease, diagnosis, and treatment-that is, the emphasis is on process rather than specialized content.

There are many fine texts that provide detailed discussions of the medical history and phys­ical examination. This instruction is not intended to replace these comprehensive approaches but rather to summarize methods and outline the basic principles essential to data collection.

The authors of this book have all been involved in teaching the Introduction to Clinical Med­icine course at the Ukrainien Academy of Medicine and Dentistry. Their experience has informed the problem ­based approach used in this book. This book is structured to allow students to review a set of skills that will enable them to approach undifferentiated medical problems systematically and with confidence in preparation for clinical clerkships.

I. Kajdashev, M. Rasin

LESSON 1,2. RADIATION EMERGENCY

Lesson 1. Biologic effects of radianion.

All organisms are continuously exposed to radiation from either natural or synthetic sources. In the United States, the average dose of radiation an individual receives per year is estimated to be 3.6 milliSieverts (mSv), 80% of which is from natural sources and 20% of which is from man-made sources. The full effects of low-dose natural radiation are not known, but high doses have been shown to be carcinogenic. At very high-dose exposures over a short period of time, immediate and lethal health effects can occur.

Generally, the toxicity caused by radiation is directly related to the quantity of energy deposited into the living organism and the subsequent disruption of metabolic and reproductive pathways. Low-level exposure from accidental contact with radioactive isotopes in laboratory research may lead to relatively minor toxicity. Alternatively, acute sickness and even death may occur after the inappropriate handling of high-level radioactive material such as cobalt-60 from radiographic or radiotherapy machinery. In a terrorism context, a radiation dispersal device (RDD), “dirty bomb,” could result in conventional blast and thermal injuries. If these devices are laced with significant amounts of radioactive material, the additional risk of radiation exposure would exist for both bomb victims and rescue workers. Detonation of nuclear weapons or improvised nuclear devices would lead to catastrophic blast and thermal injuries in addition to far-reaching lethal radiation consequences.

Over the past 50 years, most radiation incidents have had nonlethal consequences. According to the Radiation Accident Registry maintained by the Radiation Emergency Assistance Center/Training Site (REAC/TS) at the Oak Ridge Institute, from 1944-1999, 403 radiation accidents occurred worldwide, with 243 of those occurring in the United States. Of the total, 303 involved radiation devices from sealed sources or x-ray machinery, 81 involved radioisotopes, and 19 involved nuclear reactors. These incidents have led to 120 total deaths: 30 in the United States, 2 in Great Britain, and 32 in the former USSR

Radioactivity

Radioactive decay is the process in which unstable atomic nuclei assume a more stable configuration by emitting particles with kinetic energy (alpha or beta particles) or electromagnetic waves (gamma rays). If a person is exposed to these high-energy particles or electromagnetic waves, energy is deposited into the tissues and can cause injury.