Gastrointestinal Decontamination

OVERVIEW

The role for digestive tract decontamination depends on:

  1. severity of poisoning
  2. time from ingestion
  3. risk of intervention

ACTIVATED CHARCOAL

  • 1g/kg
  • usually given if patient presents within 1 hour of ingestion, but varies according to agent
  • can reduce absorption of many drugs: aspirin, paracetamol, phenobarbitone, digoxin, carbamazepine, theophylline, phenytoin
  • little value with: acids, alkalis, arsenic, bromide, cyanide, DDT, ethanol, ethylene glycol, heavy metals, hydrocarbons, iodide, iron, lithium, methanol (highly lipophilic drugs)
  • repeat doses are not usually indicated unless ingestion of large amounts and SR preparations

INDUCED EMESIS

  • ipecac
  • no longer in use
  • induces risk without any evidence of decreased absorption

GASTRIC LAVAGE

  • perform early ( decreases absorption
  • may be useful within 4 hours of large, lethal doses of drug
  • associated with visceral damage and aspiration
  • may be additionally beneficial if combined with activated charcoal
  • don’t give with corrosive, caustic, acids or petroleum ingestion
  • place patient semi-prone and head down -> large bore N/G -> aspirate stomach -> 1mL/kg of H2O at body temperature instilled and suctioned -> repeated until water is clear

WHOLE BOWEL IRRIGATION

  • using polyethylene glycol (golytely)
  • decreases absorption by decreasing transit time
  • suitable for conscious patients who have ingested tablets that don’t bind well to charcoal and can be identified on a plan radiograph
  • don’t use with charcoal
  • 1-4 L/hr until patient passes clear fluid from bowel
  • 20mL/kg/hr in paediatrics

ENDOSCOPY

  • rare, toxic metals, body packer

SURGICAL REMOVAL

  • rare, e.g. body packer with bowel obstruction

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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