General methods for treatment Flashcards
who should we really avoid emesis in
someone losing consciousness or substances that can put someone into a coma or cause a seizure. puts patient at risk of aspiration
no gag reflex
corrosive agents
problem with activated charcoal studies
patients were all healthy volunteers not like actual people that present to emerg
unethical to make a proper study
complications of emesis
aspiration pneumonitis
bleedings
GIT rupture
contraindications to gastric lavage
corrosive gents
pertoleum distillate
complications of gastric lavage
cardiac arrhythmia low oxygen laryngospasm pharingeal injury esophageal or gastric perforation
gastric lavage technique
largest diameter tube possible
patient in supine on left side with head down below level of the stomach
airway protected with a cuffed endotracheal tube
aspirate gastric contents
instill 250ml aliquots of warm water followed by draining
repeat until clear
how does activated charcoal work
physically adsorbs by hydrogen bonding, dipole and van der waals forces
has a large surface area to bind to then
binding decreases systemic absorption, can bind some poisons that have left the stomach
activated charcoal contraindications
ingestion of caustic (burn or corrode) substances
presence of ileus or bowel obstruction bc need to be able to eliminate the activated charcoal
activated charcoal complications
vomiting aspiraion pneumonitis constipation GI obstruction charcoal empyema - gets into peritoneal cavity
activated charcoal technique
administered oral or by gastric tube
30-100g as a slurry in water
how does multiple dose activated charcoal work
ensures marked serum to GI lumen concentration gradient pulling more toxin from blood to GI - works for IV drugs
what is catharsis
whole bowel irrigation using cathartics (increases defecation)
whole bowel irrigation indication
ingestion of iron or zinc salts
ingestion of SR products
ingestion of crack vial
ingestion of drug packets (massive OD)
whole bowel irrigation and cathartics contraindications
uncooperative patients
presence of ileus or GI obtruction
GI bleeding or perforation
whole bowel irrigation and cathartics complications
abdominal cramping vomiting profuse diarrhea hyperchloremia **monitor electrolytes
whole bowel irrigation technique
administer large volumes isotonic nonabsorbable polyethylene glycol/electrolyte solution until rectal discharge looks like the fluid administered
actions of cathartics
less violent way to move th poison or poison/charcoal complex through the GIT
can help remove poison, decrease absorption
examples of cathartics
sorbitol
magnesium citrate
magnesium or sodium sulfate
how does dilution work
water or milk fluid admin
when is dilution good
first few minutes after ingestion
value in ingestion of corrosive agents
contraindications to dilution
coma or convulsions bc there is a risk of vomiting
ingestion of strong acid - reacts with water and stomach can explode
ways to enhance elimination
diuresis peritoneal dialysis multiple dose activated charcoal hemodialysis hemoperfusion hemofiltration
indications for enhancement of elimination
patients who fail to respond to full supportive care
normal route of elimination of the toxin is impaired ex. renal dysfunction
patients sho the amount of toxin absorbed or plasma concentration indicate high risk of mortality
for patients who have concurrent disease, elderly, infants
manipulation of pH for diuresis objective
increase renal clearance
which poisons does manipulation of pH work on
poisons that are excreted in urine
alkaline diuresis and what it works for
give sodium bicarb iv to increase urinary pH to 7-8
increased renal excretion of salicylate, isoniazid, phenobarbital
acid diuresis and what it works on
give ammoniumchloride iv to reduce urinary pH to 4.5-5.5
weak bases such as amphetamines
no evidence of efficacy
what is forced diuresis
volume expansion with sodium containing solutions
works is glomerular filtration is an important determinant of excretion
riskd of forced diuresis
volume overload manifested by pulmonary and cerebral edema
metabolic alkalosis
hypokalemia
how to do forced diuresis
furosemide iv
monitoring of forced diuresis
monitor electrolytes
fluid balance
acidbase balance
response to diuretic
which drugs can be eliminated with peritoneal extracorporeal techniques
water soluble low MW poorly protein bound low Vd ex alcohol, lithium
problems with hemodialysis
takes 4-8hrs
often not available
requires anticoagulation with heparin
hemodialysis indications
poison dialysable patient deteriorating despite care severe electrolyte problems lethal blood levels prolonged coma risk of renal failure
hemodialysis complications
clotting and leaking of blood from around connections embolus hypotension convulsions arrhythmias infections
charcoal advantage over dialysis
can remove drugs that are highly protein bound
what is charcoal hemoperfusion
cartridge containing a sorbent with a large surface area that gets changed every couple of hourse
requires anticoagulation
complications similar to hemodialysis
how does hemofiltration work
movement of plasma across semipermeable membrane in response to hydrostatic pressure gradient
no dialysate on other side of membrane
small solutes are transported across the membrane following the water while larger solutes are excluded
advantages of hemofiltration
continue therapy for 24hr
remove drugs that distribute slowly from tissue binding sites and from the intracellular compartment
fast
disadvantages of hemofiltration
rate of removal of drugs may not be sufficient to benefit critically ill
complex
experienced ICU staff required for monitoring
clearances achieved are lower than in hemodialysis
whats plasmapheresis and exchange transfusion used for
eliminate molecules with large MW
remove plasma proteins
problems with plasmapheresis and exchange transfusion
risk of infections and allergic reactions
expensive
