Decontamination Process Flashcards
(115 cards)
1
Q
Decontamination procedures should be undertaken simultaneously with
A
- initial stabilization
- diagnostic assessment
- laboratory evaluation
2
Q
involves removing toxins from the GIT or skin
A
Decontamination
3
Q
After a delay of 60 minutes or more, _____________ of the ingested dose is removed by emesis or gastric lavage.
A
very little
4
Q
Removing of poisons in the GIT can be done by the ff:
A
Emesis
Gastric lavage
Activated charcoal (AC)
Laxatives/Cathartics
5
Q
most convenient way of emptying the stomach
A
Syrup of ipecac-induced emesis
6
Q
used mainly for prehospital treatment of many ingestions
A
Syrup of ipecac-induced emesis
7
Q
Waiting period for syrup of ipecac to take effect
A
20-30 mins
8
Q
considered as first-aid in poisoning
A
Syrup of ipecac
9
Q
Syrup of ipecac adr
A
cardiac problems like cardiac
arrhythmias and cardiomyopathy
10
Q
Alternative for Syrup of ipecac
A
soap-water solution
11
Q
Used for early initial management of oral poisonings particularly in home.
A
Syrup of ipecac
12
Q
Used to remove ingested agents not adsorbed by active charcoal.
A
Syrup of ipecac
13
Q
Used to remove sustained-release or enteric coated tablets
A
Syrup of ipecac
14
Q
Contraindications of Syrup of ipecac
A
- Obtunded, comatose or convulsing patient.
- Ingestion of a substance likely to cause rapid or abrupt coma or seizures (eg, cyclic antidepressants, camphor, cocaine, isoniazid, strychnine).
- Ingestion of a corrosive agent (eg, acids, alkali, strong oxidizing agents).
- Ingestion of a simple aliphatic hydrocarbon
15
Q
Examples of corrosive agents
A
acids, alkalis, strong oxidizing agents
16
Q
Examples of simple aliphatic hydrocarbon
A
ethane, propane, butane, gasoline, hexane
17
Q
In 20% of children, the use of SOI causes
A
drowsiness
18
Q
In 25% of children, the use of SOI causes
A
diarrhea
19
Q
Tear or bleeding in the GIT due to excessive coughing or forceful vomiting
A
Mallory-Weiss tear
20
Q
Repeated daily use of SOI may result in
A
cardiac arrhythmias and cardiomyopathy
21
Q
Dose of SOI in children ages 6-9 months
A
5mL
22
Q
Dose of SOI in children ages 9-12 months
A
10mL
23
Q
Dose of SOI in children ages 1-12 years
A
15mL
24
Q
Dose of SOI in children ages 12 years and above
A
30mL
25
Other names for gastric lavage
Stomach pump or Gastric irrigation
26
more invasive than ipecac induced emesis
Gastric lavage
27
common procedure in most emergency departments and is safe if carefully performed
Gastric lavage
28
Used as lavage solution
NSS or 0.9% saline solution (body temp.)
29
mouth - esophagus - stomach
Orogastric
30
nose - esophagus - stomach
Nasogastric
31
used for massive poisoning
Gastric lavage
32
Used to remove ingested liquid and solid drugs and poisons when the patient has taken a massive overdose
Gastric lavage
33
Used to dilute and remove corrosive liquids from the stomach and to empty the stomach in preparation for endoscopy
Gastric lavage
34
CI in the ingestion of a sustained-release or enteric-coated tablets.
Gastric lavage
35
Adverse effects of Gastric Lavage
Perforation of the esophagus or stomach
Nosebleed from nasal trauma during passage of the tube.
Inadvertent tracheal intubation.
Vomiting resulting in pulmonary aspiration of gastric contents in an obtunded patient without airway protection.
36
A highly ADSORBENT powdered material made from distillation of wood pulp.
Activated Charcoal
37
given alone without prior gastric emptying
Activated Charcoal
38
more effective than emesis and lavage procedures
Activated Charcoal
39
Components of Universal Antidote
○ Activated charcoal
○ Tannic acid
○ Magnesium oxide
40
Used for: Barbiturates (Phenobarbital, Pentobarbital), Carbamazepine, ASA
AC
41
AC does not bind to
Iron, lithium, potassium, acids, alkalis
42
AC binds poorly to
alcohols and cyanide
43
Used after any toxic ingestion to limit drug absorption form the gastrointestinal tract
AC
44
Given if the offending substance is not known to be well adsorbed to charcoal.
AC
45
Charcoal with ___________ may cause excessive diarrhea, dehydration and hypernatremia, especially in young children and elderly persons.
sorbitol
46
Charcoal with sorbitol may cause
excessive diarrhea, dehydration and hypernatremia
47
drastic laxatives
cathartics
48
Used to enhance gastrointestinal transit of the charcoal-toxin complex, decreasing the likelihood of desorption of toxin or development of a charcoal bezoar
Laxatives/Cathartics
49
Used to hasten the passage of iron tablets and other ingestions not adsorbed by charcoal.
Laxatives/Cathartics
50
Na-containing cathartics is CI in px with
fluid overload
51
Mg-containing cathartics is CI in px with
renal insufficiency
52
______________ cathartics are not recommended
oil-based
53
made from cellulose and other non-digestive polysaccharides
bulk forming laxatives
54
swells when wet
bulk forming laxatives
55
Ex. sterculia/Indian tragacanth, wheat bran, and methylcellulose
bulk forming laxatives
56
aka lubricant laxative
emollient laxative
57
Ex. mineral oil
emollient laxative
58
soften the stool
stool softener
59
Ex. Docusate sodium
stool softener
60
Increases osmotic pressure in the GIT
Saline laxatives
61
Ex. KNa tartrate, Na bisphosphate, Na phosphate
Saline laxatives
62
Act by producing local irritation, thus stimulating peristalsis
Stimulant laxatives
63
Ex, senna, bisacodyl, cascara
Stimulant laxatives
64
Cascara bark
Rhamnus purshiana
65
Last line tx for GIT poisoning
hemodialysis
66
more efficient than peritoneal dialysis
hemodialysis
67
Blood is taken from a large vein usually the femoral vein.
hemodialysis
68
Hemodialysis is used for drugs with small volume of distribution (< 0.5 L/kg)
Ethylene glycol
Methanol
Warfarin
Paraquat
Ethanol
Theophylline
Lithium
Salicylate
Long-acting barbiturates
Phenytoin
69
Hemodialysis is also used for Large Volume of Distribution (>0.5
L/kg)
Beta-blocker: Metoprolol, Timolol, Propranolol (PMT)
70
a technique of removing poisons from the blood by passing it through a tube
hemoperfusion
71
It removes many high-molecular weight toxins that have poor water solubility.
hemoperfusion
72
may enhance whole body clearance of
▪ Salicylate
▪ Theophylline
▪ Phenytoin
▪ Carbamazepine
▪ Ethchlorvynol
▪ Phenobarbital
hemoperfusion
73
It is a technique of removing poisons from the blood by passing it to a tube.
hemoperfusion
74
Previously popular but of unproved value
forced diuresis
75
may cause volume overload and electrolyte abnormalities and is not recommended
forced diuresis
76
Renal elimination of a few toxins can be enhanced by
alteration of urinary pH
77
Aspirin has enhance excretion in ______ urine
basic
78
Acidic drug + Basic urine
excretion
79
Basic drug + Acidic urine
excretion
80
Acidic drug + Acidic urine
reabsorption
81
Basic drug + Basic urine
reabsorption
82
Sodium bicarbonate is given not to overcome acidosis but instead alkalinize the urine in order to permit ion trapping to occur.
Salicylate poisoning
83
Salicylate ionizes in alkaline urine, prevents its reabsorption and allows it to be excreted.
Salicylate poisoning
84
Excess water or salt intake over loss in the presence of impaired kidney function leads to
edema and pulmonary edema
85
inadequate water intake impairs the ability of functioning kidneys to _______ toxic substances
excrete
86
Water deficits should be replaced by administering
water without electrolyte
87
Water deficits should be replaced by administering water without electrolyte
5 or 10% dextrose in distilled water IV, or water by mouth
88
Electrolyte imbalance after poisoning may be a result of
vomiting, diarrhea, kidney damage
89
If renal function is normal and the thirst mechanism is intact, water and electrolyte imbalances can be corrected relatively easily by administering
maintenance requirements
90
Sodium bicarbonate increases blood pH and prevents development of
cardiac arrhythmias
91
Maintenance of normal body temperature is important in poisoning because ____________ increases the requirement of the body for O2, food, minerals, and water.
hyperthermia
92
A body temperature rise of 0.8ºC increases the metabolism by about
10%
93
detoxification and excretion of poisons is also correspondingly slowed and circulation is impaired
hypothermia
94
Body temperature up to 40ºC can be controlled by __________________________ with adequate air circulation or a cooling blanket
applying wet towels
95
increases the cardiac and renal loads
hyperthermia
96
High temperature requires the frequent application of towels wet with water at ______ or immersion of the extremities in water at approximately ______.
10ºC ; 25ºC
97
If the body temperature is below 35ºC, the patient should be warmed by immersion of the entire body or of the extremities in water not to exceed
42ºC
98
Apply blankets or an electric blanket to avoid unnecessary ________ after the patient leaves the water.
chilling
99
If the skin temperature exceeds 42ºC, local tissue injury with capillary stasis and edema may cause
circulatory collapse
100
What is the maximum amount of glucose that can be given IV daily?
3L of 5% or 10% glucose
101
higher concentrations of glucose tend to be associated with
glycosuria
102
One liter of 5% glucose supplies how many kcal?
200 kcal
103
In order to avoid pulmonary edema
fluid intake should not exceed fluid loss
104
any agent that neutralizes a poison or otherwise counteracts or opposes it or its actions
antidote
105
Remove the poison from the body
emetics and cathartics
106
Mechanically prevent its absorption
demulcent
107
Change the physical state or chemical composition
sodium sulfate for barium
108
Act upon the functions of the body so as to overcome the effects of its absorption.
antidote
109
one which makes the poison harmless by chemical alteration of the poison
chemical, true or specific antidote
110
an agent that removes the poison without changing it, or so coats the surface of the organ so that absorption is prevented
Mechanical antidote
111
agent that acts upon the system so as to counteract the effect of the poison
Physiological antidote, antagonist or symptomatic antidote
112
Example: chloral hydrate for strychnine convulsions
Physiological antidote, antagonist or symptomatic antidote
113
TYPES OF ANTIDOTES (BASED ON
PROPERTIES)
1) Chemical, true or specific antidote
2) Mechanical antidote
3) Physiological antidote, antagonist or symptomatic antidote
114
antagonist to strychnine
Chloral hydrate
115
DOC for Warfarin toxicity
Vitamin K
