exposures, whereas destruction of the containers and dispersal of their contents could also lead to contamination A “dud” nuclear weapon that does not undergo a nuclear fission reaction would still disperse radioactive materials by the associated conventional explosion, leading to contamination in addition to effects from the conventional explosion itself A nuclear weapon effectively detonated by a terrorist group might be relatively small scale but still capable of widespread damage, including thermal and blast effects from the denotation along with contamination and exposure of affected persons Triage Considerations Triage and management should focus on securing ABCs (airway, breathing, circulation) and monitoring vital signs Major trauma, burns, and respiratory injury should be treated first No survivable radiation injury requires direct immediate lifesaving treatment; hence, medical staff should focus their attention on the treatment of non–radiation-related, life-threatening conditions Once stabilized, the radiation-related injuries can be addressed In addition to routine trauma labs, it is recommended that a CBC be obtained to assess lymphocyte count Because there is no immediate treatment of radiation exposure, the problem of radioactive contamination should be addressed first In most circumstances, a Geiger counter can be used to determine the presence of contamination The probability of contamination can be assessed by obtaining an accurate description of the accident and the likely radiation source If the patient is a radiation worker, finding his or her radiation badge and performing a “reenactment” of the accident may be critical for dose estimation Management and Diagnostic Studies Internal Contamination Treatment of internal contamination is most effective if initiated promptly The requirement for prompt treatment is a dilemma for the physician as it is difficult to determine if internal contamination is present until the external contamination has been removed Moistened cotton Q-tips can be used to perform nasal swabs If these show radioactivity, inhalation of radioactive materials is possible The nature of the accident may provide clues to the possibility of internal contamination (e.g., a fire with smoke leading to the inhalation of radioactive particles) The most effective treatment requires knowledge of the radionuclide involved and its chemical form This information is usually not immediately available Fortunately, there are simple general treatment measures that can be