17: Decontamination

Question 1

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

Answer 1

2- never neutralize, chemical neutralization can generate heat and potentially create worse injury

Question 2

_____________ rapidly damage corneal surface and can cause permanent scarring

Answer 2

Corrosive agents

Question 3

in eye decontamination, you should flush for minimum _______

Answer 3

15 minutes

Question 4

why is irritation/ smell not always reliable in inhalation decontamination

Answer 4

olfactory fatigue

Question 5

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

Answer 5

2

Question 6

water solubility of gasses can impact (3 things)

Answer 6

location of sx, likelihood of detection, likelihood of removal from area, onset of sx, risk of delayed pulmonary edema

Question 7

3 GI decontamination options

Answer 7

gastric lavage
whole bowel irrigation
activated charcoal

Question 8

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

Answer 8

4

Question 9

which 7 toxins may use gastric lavage to decontaminate

Answer 9

TCAs, salicylates, CCBs, BB, colchicine, iron, paraquat

Question 10

gastric lavage is contraindicated in

Answer 10

comatose pts w/out airway secured, convulsing pts

Question 11

AEs of gastric lavage

Answer 11

perforation of esophagus or stomach, nose bleed (NG vs OG), inadvertent tracheal intubation, vomiting/ aspiration

Question 12

list 3 drawbacks of gastric lavage

Answer 12

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

Question 13

whole bowel irrigation is done by

Answer 13

administration of PEG electrolyte solution via NG until rectal effluent clear

Question 14

what is the PEG dose for whole bowel irrigation

Answer 14

2L/hr for adults, 0.5L/hr for children

Question 15

when might whole bowel irrigation be considered

Answer 15

for SR preparations or substances not bound to activated charcoal
SR BB, CCB, lithium, iron, body packers, lead objects

Question 16

when would you recommend IPECAC

Answer 16

never- delays admin of charcoal

Question 17

what is the most useful management strategy for ingestion OD

Answer 17

activated charcoal

Question 18

AC has a SA of _________ and is made from ______ that is activated by steam, oxygen, CO2

Answer 18

Surface area of 1000m2/gm made from low ash wood pulp broken down to fine granular form activated by steam, oxygen, CO2

Question 19

AC likely works best if

Answer 19

given within hours of OD- but may be given later

Question 20

ATOM2 says AC can be given up to ___ hrs post APAP OD

Answer 20

4hrs

Question 21

what is the ideal ratio of charcoal/drug

Answer 21

10;1

Question 22

common AC dose recommended is

Answer 22

1g/kg PO

Question 23

what substances are not adsorbed to AC

Answer 23

heavy metals, iron, lithium, potassium, alcohols, cyanide

Question 24

CIs to AC

Answer 24

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

Question 25

AC doses given >1hr are sometimes rec to prevent

Answer 25

ongoing absorption of agents that persist in the GIT (modified release preparations)

Question 26

why might repeat doses of AC be given

Answer 26

to increase rate of elimination of some drugs

Question 27

AC may be given as an elimination strategy in _________________ and _____________

Answer 27

those that have a small volume of distribution or undergo enterohepatic or enterogastric recirculation