2. Management of the poisoned patient II. Decontamination

Question 1

What is decontamination?

Answer 1

Decontamination is the removal of any unabsorbed poison (insecticides, solvents) from the skin or gastrointestinal tract.

Question 2

Charcoal is a good option for decontamination. In which situations could charcoal be a good treatment option?

Answer 2

1. amitriptyline
2. barbiturates
3. carbamazepine
4. digitalis glycosides
5. phencyclidine
6. propoxyphene
7. theophylline
8. tricyclic antidepressants
9. valproic acid.

Question 3

What are the uses of Cathartics?

Answer 3

Cathartics such as sorbitol can decrease absorption and hasten removal of toxins from the gastrointestinal tract

Question 4

What are the gastric lavage rules?

Answer 4

1. Remove noncorrosive drugs
2. Awake patient
3. From a comatose patient with a cuffed endotracheal tube
4. In the past inducing vomiting (emesis), mostly by administering syrup of ipecac in a conscious patient was performed. However risks of aspiration have been shown to outweigh the benefits.

Question 5

In which situations could charcoal not be effective in decontamination and should therefore be prohibited?

Answer 5

1. iron
2. lithium
3. potassium
4. Poorly binds alcohols and cyanide

Question 6

Whole bowel irrigation with polyethylene-glycol electrolyte solution does what?

Answer 6

Enhances gut decontamination

Question 7

What are cathartics?

Answer 7

A cathartic is a substance that accelerates defecation. This is in contrast to a laxative, which is a substance that eases defecation, usually by softening feces. It is possible for a substance to be both a laxative and a cathartic. Cathartics such as sorbitol, magnesium citrate, magnesium sulfate, or sodium sulfate were previously used as a form of gastrointestinal decontamination following poisoning via ingestion. They are no longer routinely recommended for poisonings. High-dose cathartics may be an effective means of ridding the lower gastrointestinal tract of toxins; however, they carry a risk of electrolyte imbalances and dehydration. Catharsis can be an effect of pesticide poisonings, such as with elemental sulfur.