17: Decontamination Flashcards
which of the following is false about skin decontamination
1. skin should be flushed with copious amounts of water- remembering behind the ears, under nails, and in folds of skin
2. skin may be neutralized if acidic or basic substances were in contact
3. soap and shampoo should be used for oily substances
4. all of the above are true
2- never neutralize, chemical neutralization can generate heat and potentially create worse injury
_____________ rapidly damage corneal surface and can cause permanent scarring
Corrosive agents
in eye decontamination, you should flush for minimum _______
15 minutes
why is irritation/ smell not always reliable in inhalation decontamination
olfactory fatigue
which is more likely to be inhaled deeply into LRT and cause delayed onset pulmonary toxicity
1. soluble gasses
2. insoluble gasses
3. fumes
4. light gasses
2
water solubility of gasses can impact (3 things)
location of sx, likelihood of detection, likelihood of removal from area, onset of sx, risk of delayed pulmonary edema
3 GI decontamination options
gastric lavage
whole bowel irrigation
activated charcoal
gastric lavage mage be used in
1. massive OD
2. agents that slow gastric emptying
3. where the patient is unconscious
4. 1+2
5. all of the above
4
which 7 toxins may use gastric lavage to decontaminate
TCAs, salicylates, CCBs, BB, colchicine, iron, paraquat
gastric lavage is contraindicated in
comatose pts w/out airway secured, convulsing pts
AEs of gastric lavage
perforation of esophagus or stomach, nose bleed (NG vs OG), inadvertent tracheal intubation, vomiting/ aspiration
list 3 drawbacks of gastric lavage
does not reliably remove undissolved pills
SR or EC tablets esp difficult to remove
lavage unlikely to return intact tablets
may delay use of charcoal
benefits decrease with time
whole bowel irrigation is done by
administration of PEG electrolyte solution via NG until rectal effluent clear
what is the PEG dose for whole bowel irrigation
2L/hr for adults, 0.5L/hr for children
when might whole bowel irrigation be considered
for SR preparations or substances not bound to activated charcoal
SR BB, CCB, lithium, iron, body packers, lead objects
when would you recommend IPECAC
never- delays admin of charcoal
what is the most useful management strategy for ingestion OD
activated charcoal
AC has a SA of _________ and is made from ______ that is activated by steam, oxygen, CO2
Surface area of 1000m2/gm made from low ash wood pulp broken down to fine granular form activated by steam, oxygen, CO2
AC likely works best if
given within hours of OD- but may be given later
ATOM2 says AC can be given up to ___ hrs post APAP OD
4hrs
what is the ideal ratio of charcoal/drug
10;1
common AC dose recommended is
1g/kg PO
what substances are not adsorbed to AC
heavy metals, iron, lithium, potassium, alcohols, cyanide
CIs to AC
drowsy pts (airway must be protected)
risk of pulmonary aspiration if vomiting occurs (esp in drowsy)
acid/ alkali ingestion (esp where endoscopy is planned)
obtunded pts at risk for aspiration
intestinal obstruction
AC doses given >1hr are sometimes rec to prevent
ongoing absorption of agents that persist in the GIT (modified release preparations)
why might repeat doses of AC be given
to increase rate of elimination of some drugs
AC may be given as an elimination strategy in _________________ and _____________
those that have a small volume of distribution or undergo enterohepatic or enterogastric recirculation
