Decontamination of the Poisoned Patient

Key considerations

The lecture duration is 23min.

0.5 CPD Points, 0.5 CEUs, 0.5 CME credits approval pending.
Accredited by CPDUK, CBRN and Provider Pending.

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Rais Vohra
Emergency physician, medical toxicologist, and public health officer for Fresno County, California, USA
Lecture Summary

Decontamination is defines as removal of a toxin/contaminant from body tissues before the toxin is internalized. Decontamination of the skin and eyes centers on copious irrigation with a non-irritating fluid such as water, saline or lactated ringers solution. Decontamination of the GI tract is designed to prevent poison absorption by the gut lumen. Decisions about decontamination should be made early in the course of management of the poisoned patient. The main techniques used include activated charcoal, gastric lavage and whole bowel irrigation. Charcoal is an inert substance that readily adsorbs most materials and traps them in small pores on its surface, thereby preventing their further absorption and sometimes even pulling the toxins out of the blood stream back into the gut. Charcoal aspiration is a risk in patients without adequate airway reflexes. Gastric lavage is an invasive procedure requiring a large-bore orogastric tube and patient cooperation; the risk-benefit ration favors lavage only if the ingestion was recent and potentially deadly. Whole bowel irrigation is a procedure using an inert liquid, polyethylene glycol solution, which flushes the GI tract of toxin by inducing diarrhea within 6 to 12 hours. Each of the these techniques has advantages and drawbacks, and in some patients no decontamination modality is safe/suitable.

Target Audience

Emergency Medicine Doctors
Emergency Medicine Nurses
Paramedics
Rural GP's

Learning Objectives:

Upon completion of this activity, you should be able to:

  • Review general approach to the poisoned patient