Decontamination Process Flashcards
Decontamination procedures should be undertaken simultaneously with
- initial stabilization
- diagnostic assessment
- laboratory evaluation
involves removing toxins from the GIT or skin
Decontamination
After a delay of 60 minutes or more, _____________ of the ingested dose is removed by emesis or gastric lavage.
very little
Removing of poisons in the GIT can be done by the ff:
Emesis
Gastric lavage
Activated charcoal (AC)
Laxatives/Cathartics
most convenient way of emptying the stomach
Syrup of ipecac-induced emesis
used mainly for prehospital treatment of many ingestions
Syrup of ipecac-induced emesis
Waiting period for syrup of ipecac to take effect
20-30 mins
considered as first-aid in poisoning
Syrup of ipecac
Syrup of ipecac adr
cardiac problems like cardiac
arrhythmias and cardiomyopathy
Alternative for Syrup of ipecac
soap-water solution
Used for early initial management of oral poisonings particularly in home.
Syrup of ipecac
Used to remove ingested agents not adsorbed by active charcoal.
Syrup of ipecac
Used to remove sustained-release or enteric coated tablets
Syrup of ipecac
Contraindications of Syrup of ipecac
- Obtunded, comatose or convulsing patient.
- Ingestion of a substance likely to cause rapid or abrupt coma or seizures (eg, cyclic antidepressants, camphor, cocaine, isoniazid, strychnine).
- Ingestion of a corrosive agent (eg, acids, alkali, strong oxidizing agents).
- Ingestion of a simple aliphatic hydrocarbon
Examples of corrosive agents
acids, alkalis, strong oxidizing agents
Examples of simple aliphatic hydrocarbon
ethane, propane, butane, gasoline, hexane
In 20% of children, the use of SOI causes
drowsiness
In 25% of children, the use of SOI causes
diarrhea
Tear or bleeding in the GIT due to excessive coughing or forceful vomiting
Mallory-Weiss tear
Repeated daily use of SOI may result in
cardiac arrhythmias and cardiomyopathy
Dose of SOI in children ages 6-9 months
5mL
Dose of SOI in children ages 9-12 months
10mL
Dose of SOI in children ages 1-12 years
15mL
Dose of SOI in children ages 12 years and above
30mL
Other names for gastric lavage
Stomach pump or Gastric irrigation
more invasive than ipecac induced emesis
Gastric lavage
common procedure in most emergency departments and is safe if carefully performed
Gastric lavage
Used as lavage solution
NSS or 0.9% saline solution (body temp.)
mouth - esophagus - stomach
Orogastric
nose - esophagus - stomach
Nasogastric
used for massive poisoning
Gastric lavage
Used to remove ingested liquid and solid drugs and poisons when the patient has taken a massive overdose
Gastric lavage
Used to dilute and remove corrosive liquids from the stomach and to empty the stomach in preparation for endoscopy
Gastric lavage
CI in the ingestion of a sustained-release or enteric-coated tablets.
Gastric lavage
Adverse effects of Gastric Lavage
Perforation of the esophagus or stomach
Nosebleed from nasal trauma during passage of the tube.
Inadvertent tracheal intubation.
Vomiting resulting in pulmonary aspiration of gastric contents in an obtunded patient without airway protection.
A highly ADSORBENT powdered material made from distillation of wood pulp.
Activated Charcoal
given alone without prior gastric emptying
Activated Charcoal
more effective than emesis and lavage procedures
Activated Charcoal
Components of Universal Antidote
○ Activated charcoal
○ Tannic acid
○ Magnesium oxide
Used for: Barbiturates (Phenobarbital, Pentobarbital), Carbamazepine, ASA
AC
AC does not bind to
Iron, lithium, potassium, acids, alkalis
AC binds poorly to
alcohols and cyanide
Used after any toxic ingestion to limit drug absorption form the gastrointestinal tract
AC
Given if the offending substance is not known to be well adsorbed to charcoal.
AC
Charcoal with ___________ may cause excessive diarrhea, dehydration and hypernatremia, especially in young children and elderly persons.
sorbitol
Charcoal with sorbitol may cause
excessive diarrhea, dehydration and hypernatremia
drastic laxatives
cathartics
Used to enhance gastrointestinal transit of the charcoal-toxin complex, decreasing the likelihood of desorption of toxin or development of a charcoal bezoar
Laxatives/Cathartics
Used to hasten the passage of iron tablets and other ingestions not adsorbed by charcoal.
Laxatives/Cathartics
Na-containing cathartics is CI in px with
fluid overload
Mg-containing cathartics is CI in px with
renal insufficiency
______________ cathartics are not recommended
oil-based
made from cellulose and other non-digestive polysaccharides
bulk forming laxatives
swells when wet
bulk forming laxatives
Ex. sterculia/Indian tragacanth, wheat bran, and methylcellulose
bulk forming laxatives
aka lubricant laxative
emollient laxative
Ex. mineral oil
emollient laxative
soften the stool
stool softener
Ex. Docusate sodium
stool softener
Increases osmotic pressure in the GIT
Saline laxatives
Ex. KNa tartrate, Na bisphosphate, Na phosphate
Saline laxatives
Act by producing local irritation, thus stimulating peristalsis
Stimulant laxatives
Ex, senna, bisacodyl, cascara
Stimulant laxatives
Cascara bark
Rhamnus purshiana
Last line tx for GIT poisoning
hemodialysis
more efficient than peritoneal dialysis
hemodialysis
Blood is taken from a large vein usually the femoral vein.
hemodialysis
Hemodialysis is used for drugs with small volume of distribution (< 0.5 L/kg)
Ethylene glycol
Methanol
Warfarin
Paraquat
Ethanol
Theophylline
Lithium
Salicylate
Long-acting barbiturates
Phenytoin
Hemodialysis is also used for Large Volume of Distribution (>0.5
L/kg)
Beta-blocker: Metoprolol, Timolol, Propranolol (PMT)
a technique of removing poisons from the blood by passing it through a tube
hemoperfusion
It removes many high-molecular weight toxins that have poor water solubility.
hemoperfusion
may enhance whole body clearance of
▪ Salicylate
▪ Theophylline
▪ Phenytoin
▪ Carbamazepine
▪ Ethchlorvynol
▪ Phenobarbital
hemoperfusion
It is a technique of removing poisons from the blood by passing it to a tube.
hemoperfusion
Previously popular but of unproved value
forced diuresis
may cause volume overload and electrolyte abnormalities and is not recommended
forced diuresis
Renal elimination of a few toxins can be enhanced by
alteration of urinary pH
Aspirin has enhance excretion in ______ urine
basic
Acidic drug + Basic urine
excretion
Basic drug + Acidic urine
excretion
Acidic drug + Acidic urine
reabsorption
Basic drug + Basic urine
reabsorption
Sodium bicarbonate is given not to overcome acidosis but instead alkalinize the urine in order to permit ion trapping to occur.
Salicylate poisoning
Salicylate ionizes in alkaline urine, prevents its reabsorption and allows it to be excreted.
Salicylate poisoning
Excess water or salt intake over loss in the presence of impaired kidney function leads to
edema and pulmonary edema
inadequate water intake impairs the ability of functioning kidneys to _______ toxic substances
excrete
Water deficits should be replaced by administering
water without electrolyte
Water deficits should be replaced by administering water without electrolyte
5 or 10% dextrose in distilled water IV, or water by mouth
Electrolyte imbalance after poisoning may be a result of
vomiting, diarrhea, kidney damage
If renal function is normal and the thirst mechanism is intact, water and electrolyte imbalances can be corrected relatively easily by administering
maintenance requirements
Sodium bicarbonate increases blood pH and prevents development of
cardiac arrhythmias
Maintenance of normal body temperature is important in poisoning because ____________ increases the requirement of the body for O2, food, minerals, and water.
hyperthermia
A body temperature rise of 0.8ºC increases the metabolism by about
10%
detoxification and excretion of poisons is also correspondingly slowed and circulation is impaired
hypothermia
Body temperature up to 40ºC can be controlled by __________________________ with adequate air circulation or a cooling blanket
applying wet towels
increases the cardiac and renal loads
hyperthermia
High temperature requires the frequent application of towels wet with water at ______ or immersion of the extremities in water at approximately ______.
10ºC ; 25ºC
If the body temperature is below 35ºC, the patient should be warmed by immersion of the entire body or of the extremities in water not to exceed
42ºC
Apply blankets or an electric blanket to avoid unnecessary ________ after the patient leaves the water.
chilling
If the skin temperature exceeds 42ºC, local tissue injury with capillary stasis and edema may cause
circulatory collapse
What is the maximum amount of glucose that can be given IV daily?
3L of 5% or 10% glucose
higher concentrations of glucose tend to be associated with
glycosuria
One liter of 5% glucose supplies how many kcal?
200 kcal
In order to avoid pulmonary edema
fluid intake should not exceed fluid loss
any agent that neutralizes a poison or otherwise counteracts or opposes it or its actions
antidote
Remove the poison from the body
emetics and cathartics
Mechanically prevent its absorption
demulcent
Change the physical state or chemical composition
sodium sulfate for barium
Act upon the functions of the body so as to overcome the effects of its absorption.
antidote
one which makes the poison harmless by chemical alteration of the poison
chemical, true or specific antidote
an agent that removes the poison without changing it, or so coats the surface of the organ so that absorption is prevented
Mechanical antidote
agent that acts upon the system so as to counteract the effect of the poison
Physiological antidote, antagonist or symptomatic antidote
Example: chloral hydrate for strychnine convulsions
Physiological antidote, antagonist or symptomatic antidote
TYPES OF ANTIDOTES (BASED ON
PROPERTIES)
1) Chemical, true or specific antidote
2) Mechanical antidote
3) Physiological antidote, antagonist or symptomatic antidote
antagonist to strychnine
Chloral hydrate
DOC for Warfarin toxicity
Vitamin K
