more aggressive decontamination Some residual contamination may be acceptable Exposure Other than symptomatic measures, there is no immediate treatment to reverse whole-body or local radiation exposure Medically significant whole-body radiation exposure is unlikely if the patient does not present with nausea and vomiting Serial CBCs (with special attention to the lymphocyte count) every several hours are also helpful in excluding the diagnosis of a recent large wholebody exposure to radiation ( Table 90.18 ) In the absence of other major trauma, the absolute lymphocyte count will rapidly fall in patients who have been exposed to a large radiation dose If a patient has been exposed to a large acute dose of radiation, there is little in the way of specific medical treatment in the ED The threat to the patient’s life will occur within days to weeks after the exposure and medical management includes prevention and treatment of infections, stimulation of hematopoiesis with the use of growth factors, stem cell transfusions, or platelet transfusions with severe thrombocytopenia For any accident involving radioactive materials, reports should be made to the appropriate state and federal agencies The diagnosis of a local radiation injury requires vigilance The physician should consider the possibility of a local radiation injury whenever there is an unexplained painless “burn” blister, ulceration, or necrosis of the skin A CBC to exclude an accompanying whole-body exposure and consultation with a radiation expert is indicated The prognosis of a local radiation injury depends on the dose The dose may be estimated by having a qualified physicist reconstruct the accident that led to the exposure