Decontamination After Poisoning

Dept of A & E VMU

Introduction
‡ The method of decontamination after an episode of poisoning ‡ depends on the mode of intake
² Gastrointestinal ² Topical ² Respiratory

Decontamination ‡ Gastric lavage ‡ Whole Body and hair wash ‡ Whole bowel irrigation .

Gastric lavage ‡ Indications ² All poisoning except ² Petroleum distillates ² Strong acid or alkali .

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‡ Place the patient in the left lateral position head should be lower than the rest of his body ‡ Use the largest diameter orogastric lavage tube.Procedure ‡ In patients with impaired consciousness. . A size 32 to 36 ‡ French Ewald tube is ideal.

‡ Repeat this until the lavage return is clear. manually agitate the stomach. .300 ml of lavage fluid via the tube (in children. Generally. anywhere from 5 to 20 L are required to thoroughly cleanse the stomach. ‡ Remember to save the aspirate for toxicology screening.100 ml). After that. withdraw the fluid.‡ Administer 100 . administer 50 . Then.

. activated charcoal may be administered via the orogastric lavage tube.‡ After completion of the lavage.

Potential Complications ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Aspiration pneumonia Bleeding Cardiac arrest Gagging and vomiting Perforation Psychological trauma Vasovagal effects Laryngospasm Fluid and electrolyte disturbances .

‡ It is especially useful in overdoses with enteric coated tablets and sustained release formulations.Whole Bowel Irrigation ‡ involves inducing diarrhoea by using large volumes of isotonic nonabsorbable solutions. .

‡ Whole bowel irrigation is carried out by giving the patient 2 L of polyethylene glycol orally. .

One of the more commonly used oral adsorbents is activated charcoal.Oral adsorbents are generally used in the following situations: .‡ These are used to decrease the absorption of the poison into the system. In recent years. this has been used increasingly in the initial management of poisoned patients.

.Oral Adsorbents ‡ When both emesis and lavage are contraindicated ‡ After completion of emesis or lavage ‡ In multiple doses as part of GIT dialysis Activated charcoal is inadvisable under the following conditions: ‡ Ileus or intestinal obstruction ‡ Note: multiple dose activated charcoal (MDAC) has been found to be as efficacious as haemodialysis in several studies.

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.Administration of Charcoal ‡ The dosage for adults is as follows: ‡ First dose: 1 g / kg body weight (orally or via a nasogastric tube) ‡ Subsequent doses: 0.8 hourly intervals for up to 24 hours ‡ Note: 1) commercially available charcoal tablets are not suitable as the dosage is too low and the surface area is insufficient ‡ 2) first dose of activated charcoal is preferably with sorbitol but subsequent ‡ doses should be pure activated charcoal unless no bowel movement occurs.5 g / kg body weight at 4 .

10X estimated weight of ingested chemical . prevents movement from GI tract ‡ Very effective at adsorbing substances ‡ Binds about 62% of toxin ‡ Dose ² 5 .Activated Charcoal ‡ Adsorbs compounds.

Activated Charcoal ‡ Inactivates Ipecac ‡ Do not give until vomiting stops ‡ Do not give with ² Cyanide ² Methanol ² Tylenol (+) ‡ Containers must be kept airtight .

Eye Irrigation ‡ Wash for 15 minutes ‡ Use only water or balanced salt solutions ‡ Remove contact lenses ‡ Wash from medial to lateral .