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Update (12/01): Status of patients from the JCO Criticality
More updates.....
Following my previous update (11/29), Valerie Putman (INEEL) sent me the
following message:
"Regarding dose estimate revisions: I put information I had in "Radiological
Information - Exposures" section. During ANS special session, Dr. Kunihisa
(Ken) Soda said doses were revised and Dr Shohei Kato announced new values. Dr.
Kato also indicated values were based on four estimation methods: 24Na
activation in blood, 24Na from whole body counts,
lymphocyte count, and chromosome aberration. Kato is the head of the Radiation
Risk Analysis Laboratory, Dept. of Health Physics, for JAERI. Apparently STA is
currently relying on Kato's people for best-estimates on doses, so I used Kato's
values in last update."
Thank you Valerie.
Tosh Ushino
ICN Dosimetry
tushino@icnpharm.com
==========================================================================
RBC = Red Blood Cell WBC = White Blood Cell BP = Blood Pressure
Temp = Temperature Pulse = Pulse Rate Resp = Respiration rate
CRP = C-reactive protein
Mr. A: 9.06 Sv
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11/25/99 17:00
BP: 141/88 mm Hg, Pulse: 114/min., Resp: 20/min., Temp: 38.9 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
5,200/mm^3. Radiation damage to intestine and skin is extremely critical
problem. Because of this, the patient requires massive amount of fluid and blood
products transfusion daily. Continuing problem with large volume of fluid
seeping out from the areas of injuries due to radiation burn. We have again
transplanted cultured human skin tissue. The volume of blood in bowel decreased
(655 gm from midnight to 4:00 PM). The source of blood is thought to be the
festering injuries due to radiation burn. Volume of fluid in stomach of unknown
origin is increasing.
Treatment Direction: Attempting to stem blood loss through intestine. Covering
small areas of radiation burn area at a time with cultured human skin . Continue
ventilation management, infection prevention, nutrition management, continued
transfusion management, and detailed total body management.
Others: Currently, blood pressure, pulse rate and other vital signs remain
somewhat stable, but the overall condition is very critical, requiring continued
vigilance.
11/26/99 17:00
BP: 124/80 mm Hg, Pulse: 128/min., Resp: 20/min., Temp: 39.0 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
5,900/mm^3. Radiation damage to intestine and skin is extremely critical
problem. Because of this, the patient requires massive amount of fluid and blood
products transfusion daily. Continuing problem with large volume of fluid
seeping out from the areas of injuries due to radiation burn. We have again
transplanted cultured human skin tissue provided to us from other university.
The volume of blood in bowel worsened (990 gm from midnight to 4:00 PM). The
source of blood is thought to be the festering injuries due to radiation burn.
Festering wound in duodenum is also suspected be the source of blood. Volume of
fluid in stomach of unknown origin is increasing.
Treatment Direction: Attempting to stem blood loss through intestine. Covering
small areas of radiation burn area at a time with cultured human skin . Continue
ventilation management, infection prevention, nutrition management, continued
transfusion management, and detailed total body management.
Others: Currently, blood pressure, pulse rate and other vital signs remain
somewhat stable, but the overall condition is very critical, requiring continued
vigilance.
11/27/99
- Today, at 7:02 AM, suddenly there was (heart fibrillation???) and patient
suffered cardiac arrest. Heart massage and artificial respiration commenced
immediately, and medication was provided. Heart resumed normal function at 8:14
AM after five electric shocks.
- At 10:00 AM, BP: 102/66 mm Hg, Pulse: 150/min., Resp: 27/min.
- Due to prolonged lack of circulation, we are conducting evaluation of central
nervous system function.
- The result of the 6:00 AM blood sample gas analysis showed no abnormality.
- The cause of cardiac arrest is unknown. No abnormality to heart was found. No
indication of high level of inadequate respiration. Involvement of (???reflex of
nerves through blood vessels???) strongly suspected.
- We will continue with evaluation of central nervous system function and
support of overall condition.
11/27/99
- 4:30 PM: circulation relatively stable. With medication, BP: 115/71 mm,
Pulse: 150/min, Resp: 25/min (breathing on own).
- Maintaining breathing on own and there is reflex reaction to light.
- Since there is low volume of urine, patient will be on dialysis machine
continuously.
[***Various tests were conducted and several possible cause of cardiac arrest
were ruled out. Unable to translate the possible causes they explored. They
suspect that due to some problem in liver, there was low level of oxygen in
blood, which caused some sort of erratic nerve reflexive response, and sudden
lowering of blood pressure and subsequent cardiac arrest.***]
- Drainage of water in stomach, circulation, respiratory function evaluation,
aggressive treatment.
11/28/99 17:00
- 4:00 PM: Circulation remaining relatively stable. With medication, BP: 154/98
mm, Pulse: 128/min, Resp: 28/min.
- Some improvement in respiration.
- Breathing on own and there is reflexive reaction to light, CNS function is
maintained.
- Since there is low volume of urine, patient will be on dialysis machine
continuously.
- Liver function deteriorated This is suspected to be due to cardiac arrest.
- Radiation damage to intestine and skin remains a critical problem.
- Blood in stool decreased, and the severity also decreased (440 gm from
midnight to 4:00 PM). Bleeding is observed using tube inserted into stomach
through nose (550 gm from midnight to 4:00 PM). This is thought to be from
festering wound in stomach and duodenum.
- Continuing problem with large volume of fluid seeping out from the areas of
injuries due to radiation burn.
- Because of this, the patient requires massive amount of fluid and blood
products transfusion.
- Patient continues to remain in critical condition.
11/29/99 17:00
BP: 151/92 mm Hg, Pulse: 121/min., Resp: 25/min., Temp: 37.7 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
12,700/mm^3. On dialysis machine continuously. Liver function has deteriorated
to the point where there is essentially no liver function. Radiation damage to
intestine and skin remain extremely critical problem. Because of this, the
patient requires massive amount of fluid and blood products transfusion daily.
Continuing problem with large volume of fluid seeping out from the areas of
injuries due to radiation burn. volume of blood collected through tube inserted
into stomach increased (1,285 gm from midnight to 4:00 PM).
Treatment Direction: Continue massive volume of transfusion and continue with
dialysis. Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: With medication, blood pressure, pulse and other vital signs remain
relatively stable, but due to inadequate liver function, increase in bleeding
observed, becoming even more critical to maintain vigilance.
11/30/99 17:00
BP: 136/74 mm Hg, Pulse: 118/min., Resp: 25/min., Temp: 36.4 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
12,700/mm^3. On dialysis machine continuously. Liver function has deteriorated
to the point where there is essentially no liver function. Radiation damage to
intestine and skin remain extremely critical problem. Because of this, the
patient requires massive amount of fluid and blood products transfusion daily.
Continuing problem with large volume of fluid seeping out from the areas of
injuries due to radiation burn. Bleeding from upper digestive tract increased
(1,285 gm from midnight to 4:00 PM).
Treatment Direction: Continue massive volume of transfusion and continue with
dialysis. Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: With medication, blood pressure, pulse and other vital signs remain
relatively stable, but due to inadequate liver function, increase in bleeding
observed, becoming even more critical to maintain vigilance.
12/01/99 17:00
BP: 131/69 mm Hg, Pulse: 119/min., Resp: 29/min., Temp: 37.2 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
7,700/mm^3. Since there is no urine, on dialysis machine continuously. Slight
improvement in liver function. Radiation damage to intestine and skin
continues. Continuing problem with large volume of fluid seeping out from the
areas of injuries due to radiation burn. Because of this, the patient requires
massive amount of fluid and blood products transfusion daily. Bleeding from
digestive tract decreased and the severity decreased (176 gm in bowel, 435 gm
through tube through nostril, from midnight to 4:00 PM).
Treatment Direction: Continue massive volume of transfusion and continue with
dialysis. Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: With medication, blood pressure, pulse and other vital signs remain
relatively stable, but the condition continue to require vigilance.
Mr. B 4.96 Sv
-------------------------------------------------------------------------
11/25/99
BP: 141/88 mm Hg Pulse: 114/min Resp.: 20/min Temp: 38.9 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
5,200/mm^3. Radiation damage to intestine and skin is extremely critical
problem. Because of this, the patient requires massive amount of fluid and blood
products transfusion daily.
11/26/99
With steroid medication, fever and inflammation improved. Feeling of exhaustion
strong. Some improvement observed in damaged skin. No major change to
examination result.
BP: 150/100 Pulse: 120/min, Temp (peak): 38.3 C WBC count:
12,100/mm^3 Hemoglobin: 8.6 g/dl
11/29/99
With steroid medication, fever and inflammation improved. Although skin of
entire body affected, improvement beginning to be observed over large area of
damaged skin. Damaged to liver function thought to be the result of medication
observed.
BP: 140/92 Pulse: 116/min, Temp (peak): 38.3 C WBC count:
16,620/mm^3 Hemoglobin: 8.8 g/dl
Bilirubin: 3.6 mg/dl
12/01/99
Conscious, lucid, with good spirits, and no major change to examination result.
BP: 140/82 Pulse: 120/min, Temp (peak): 38.3 C WBC count:
12,040/mm^3 Hemoglobin: 7.3 g/dl
Bilirubin: 3.4 mg/dl
-------------------------------------------------------------------------
Toshihide "Tosh" Ushino, CHP Tel: (800) 548-5100 x2413
Product Development Manager Fax: (714) 668-3149
Dosimetry Div., ICN Biomedicals, Inc. Email: tushino@icnpharm.com
3300 Hyland Ave., Costa Mesa, CA USA 92626 tushino@hotmail.com
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