Targeted Physical Examination Following a Nuclear Detonation

Physical findings suggestive of ARS

Vital signs	Skin	Nervous system	Gastrointestinal tract	Hematologic
Fever Hypotension Tachycardia Tachypnea	Erythema Edema Blistering* Desquamation*	Impaired level of consciousness Ataxia Papilledema Motor/sensory deficits Presence/absence of reflexes	Abdominal tenderness GI bleeding	Bruising* Ecchymoses* Petechiae of skin/ mucous membranes*

^*If caused by ARS may not be evident in the first 96 hours; these evolve over time. See also:

• Manage 4 Subsyndromes of ARS: interactive tool
• Cutaneous Radiation Subsyndrome: clinical details and photos

Traumatic injuries suggestive of exposure

External physical injury	Blast injury to tympanic membrane	Eye injuries	Blunt trauma	Thermal burns
Penetrating truncal injuries	Eardrum rupture (hearing loss)	Permanent visual loss (retinal scarring) Temporary flash blindness* Minor trauma Foreign bodies (including glass projectiles)*	Rupture or contusion of major air-containing organs or solid-organ injury from crush or poly-trauma	Flash burns to the skin

^*Typically expected at distances farther from ground zero

• After a nuclear detonation, certain injuries (one or more) may
  • Correlate with a victim's distance from ground zero
  • Suggest that radiation exposure may have been received
  • Serve as approximate estimates of dose until more definitive clinical biodosimetry or dose reconstruction information becomes available
  • Serve as clinical markers when considering early administration of white cell cytokines.
• For more details on physical exam, see Table 4 in
  Coleman CN, Casagrande R, Hick JL, Weinstock DM, Bader JL, Chang F, Nemhauser JB, Knebel AR. Triage and Treatment Tools for Use in a Scarce Resources - Crisis Standards of Care Setting following a Nuclear Detonation. Disaster Med Pub Health Prep. 2011 Mar; 5 Suppl 1:S111-21. [PubMed Citation]