Lec 17: Decontamination PADIS

Question 1

Waht are the 3 methods of “elimination”?

• what is the acronym to remmeber which drugs we can use hemo on?

Answer 1

1) urinary alkalanization
2) Multiple Dose Activated Charcoal (MDAC)
2) Hemo: on SMELT-V agents only.

Question 2

What does SMELT-V stand for?

Answer 2

Salicylates, methanol, ethylene glycol, lithium, theophylline, valproic acid.

Question 3

What is the general methods for DECONTAMINATING SKIN exposures?

• Do we ever NEUTRALIZE skin exposures? explain.

Answer 3

Flush with copious amounts of water (removes toxin to dcr burns and prevents absorption via skin).

• can use soap/shampoo for oily substances.
• NO, never neutralize, cuz it can cause an EXOTHERMIC RXN MAKING INJURY WORSE (just use water).

Question 4

What is the general methods for DECONTAMINATING EYE exposures? (3 steps)

Answer 4

Flush with tepid water for min 15 mins.

• remove contacts.
• check pH of eye.
• do NOT neutralize (exothermic rxns).

Question 5

What is the general methods for DECONTAMINATING INHALATION exposures?

Answer 5

• get FRESH AIR!!!
• leave area
• open windows
• use fans
• advise resucers to protect themselves.

Question 6

What are 2 more water soluble gases? what is the effect of this in terms of the location it affects?

Answer 6

ammonia, chlorine.

• Affects upper resp. track more (i.e. mucous membrans of eye, nose and throat).

Question 7

what are 2 LESS water soluble gases?

• What is the consequence of this property?

Answer 7

phosgene, and nitrogen.

• is less readily absorbed by upper mucous membranes, so more likely to be inhaled DEEPLY into the lower respiratory tract leading to DELAYED onset pulmonary toxicity.

Question 8

What are the 3 GI decontamination options?

Answer 8

Gastric lavage, Activated Charcoal, Whole bowel irrigation.

Question 9

Why do we NEVER USE IPECAC?

Answer 9

• never want to induce vomiting in toxic OD cuz of risk of aspiration.
• it also delays admin of AC (if give AC and they’re vomiting, at risk of aspiration now).
• Adverse effects of ipecac include persistent and forceful vomiting which can puncture windpipes.

Question 10

When would GASTRIC LAVAGE be considered?

• patient must also be able to _____ procedure….

Answer 10

• altho RARELY used, may be used in MASSIVE OVERDOSES of very toxic agents, or wiht agents that slow gastric emptying (salicylates, antihistamines).
• must be able to tolerate procedure, cuz they put a tube in the stomach and suck out the contents.

Question 11

What are some life threatening toxins where LAVAGE MIGHT be considered?

Answer 11

n Tricyclic antidepressants
n Salicylates
n Calcium channel blockers
n Beta blockers
n Colchicine
n Iron- doenst bind AC.
n Paraquat- very toxic insecticide.

Question 12

What are the 2 Contraindications of gastric lavage?

Answer 12

• comatose patient WITHOUT a secured airway (i.e. not intubated) .
• Convulsing patients.

Question 13

what are some possible AEs associated with gastric lavage?

Answer 13

• Risk of pefroating esophagus or stomach from tube.
• nose bleed from admin of tube.
• inadvertent tracheal intubation if tube goes down wrong pipe.
• vomiting/aspiration a risk.

Question 14

Does lavage remove un-dissolved pills?

Answer 14

no!

Question 15

what are 3 drawbacks of lavage?

• doesn’t reliably remove _______.
• may ____ use of ___.
• benefit ____ with time.

Answer 15

• doesn’t reliably remove un-dissolved pills.
• may delay use of AC.
• benefit dcr with time (Longer you wait, less liekly to be effective cuz drug would already be absorbed. )

Question 16

• what is the ideal charcoal: drug ratio to limit absorption?
• if we dont know how much toxin they took, what is the common dose of AC given?

Answer 16

• 10:1 [Goal is to get ratio of charcoal to drug of 10:1 based on how much we think they’ve taken. Want to give 10x AC the dose of poison]
• dose: 1g/kg PO

Question 17

Activated charcoal can be given up to how many hours after ingestion of APAP?

• which study showed this?

Answer 17

up to 4 hrs. Still lowers APAP and leads to lower rates hepatotoxicity.

• the ATOM 2 trial.

Question 18

What are Activated Charcoal contraindications? 3

Answer 18

C/i’d:
1) DROWSY PATIENTS (drowsy= more likely to aspirate; these ppl need ot be indtubated and given charcoal vi NG tube).

2) Intestinal obstruction/no bowel sounds ( must have bowel soubds, otherwise you’re pouring cement into a mold and will cause impaction).

3) Acid/alkali ingestion (esp wher endoscopy is requried, cuz charcoal makes everything black).

Question 19

Which substances are NOT bound by charcoal?

Answer 19

n Heavy metals: lead, mercury, arsenic

n Iron

n Lithium

n Potassium

n Alcohols

n Cyanide*

PLAIN cyanide

CAMP…. they were NOT invited to the “camp”.. NOT bound by charcoal/excluded.

Question 20

When would you consider giving MORE than ONE dose of AC? (2)

• what are the properties of the drugs that might benefit from multidose charcoal? (2)

Answer 20

• if agent was a ‘MODIFIED RELEASE’ prep.
• if you need to INCREASE THE RATE OF ELIM of some drugs:
• that have a small Vd.
• or undergo ENTEROHEPATIC RECIRCULATION.

Question 21

Describe the process of WHOLE BOWEL IRRIGATION (what is it aka?)?

Answer 21

AKA: the HOSE.

it’s where you basically give COLYTE (colonoscopy prep drugs) until what comes out the other end is clear (basically trying to flush out your gi system).

Question 22

Waht dose of colyte is given for whoel bowel irrigaiton?

Answer 22

2L/hr= adults

0.5 L/hr = children

Question 23

What are the indications for whole bowel irrigation? (6)

Answer 23

• for SR preps or agents that cant be bound by AC.
• SR bb or CCBs
• lithium
• iron
• body packers/concealers
• lead objects (ie lead BBs- want to push it out so you dont absorb the lead, since ac doesnt bind).