Gastrointestinal decontamination Flashcards
1
Q
Benefits
A
improved clinical outcome morbidity/ mortality
more benign clinical course requiring lower level supportive care
reduced need for other potentially hazardous interventions or expensive antidotes
reduced hospital LOS
2
Q
Potential risks
A
pulmonary aspiration
GI cx: Bowel obstruction/ perforation
distraction staff from resus & supportive care
Diversion of dept resources
3
Q
Single dose activated charcoal
A
Within 1st hr most agents
benefits outweigh risks
4
Q
Doesn’t work in
A
Hydrocarbons & alcohols - Ethanol -ethylene glycol -methanol -isopropyl alcohol Metals -Li -Iron -K -Lead -Arsenic -Mecury Corrosives -Acids -alkalis
5
Q
Complication AC
A
vomiting mess pulmonary aspiration misplaced NG- lung administration impaired absorption PO antidotes corneal abraision distraction staff
6
Q
Contraindications AC
A
initial resus incomplete non toxic ingestion subtoxic dose risk assess good outcome with supportive care & antidotes Decreased LOC imminent sz agent not bound to AC Corrosive agent
7
Q
AC dose
A
50 g adult
1g/kg child
Ensure no risk of aspiration
8
Q
Whole bowel irrigation indication
A
Iron OD >60 mg/kg Slow release KCl >2.5mmol/kg Life threatening slow release verapamil/ diltiazem symptomatic arsenic ingestion lead ingestion body packers
9
Q
WBI: complications
A
N&V & abdominal pain NAGMA Pulmonary aspiration distraction from resus Delayed retrieval
10
Q
WBI: contraindications
A
Risk assess good outcome with supportive care uncooperative pt inability to place NGT uncontrolled vomiting potential decreased LOC/ Sz ileus/ obstruction ? Intubated & ventilated
11
Q
WBI: administration
A
single nurse PEG- ELS solutin AC 50 g/ adult & 1g/kg child NGT PEG- 2l/ hr adult 25ml/kg child Metoclopramide End pt: effluent clear Cease if: abdominal distension/ absent bowel sounds
