Gastric lavage
if greater than 2 hrs or toxin already in intestine, gastric decontam not helpful
- helpful however if delayed emptying or decreased intest motility
- always use charcoal asap unless agent/ quantity not toxic, agent not absorbed to charcoal, or delay so long absorption is complete
- gastric emptying before charcoal- higher risk of aspiration, intubation, icu- not routinely recommended
- gastric emptying helpful if symptomatic within 1 hr, symptomatic with agents that slow gi motility, sustained release meds or massive/ life threatening amount
Does GI Decont Change Pt Outcome?
- effect only if used early- no effect if late
- however, no prospective trial has proven charcoal or ipecac- only suggests it
- also, gi decont benefit never disproved either
What Are Risks of GI Decont?
- aspiration- by cns depression, loss of gag reflex, spont or induced emesis, manipulation of airway or gi tract
- ipecac assoc with asp if used incorrectly-
- charcoal usually not assoc with asp- but can be
- charcoal asp worse than gastric content asp because causes granulomatous reaction, tissue reaction to sorbitol or povidone, increased lung microvascular permeability
- risk of gastric lavage include unnecessary intubation
- intubation for airway protection/ aspiration not 100% protective
- lavage can also damage throat, esoph, stomach
- all types of decont have risk- small but acceptable
Which Pt Not Need GI Decon?
- most preschool pts do not need decont
- no need for decon if nontoxic dose or substance or drug taken so long ago already absorbed.
- Gi decon reasonable if all pt and all symptomatic pt unless full absorption already occurred- risks of single dose low.
- However- if low risk pt and uncooperative- may not be worth trauma/ risk to staff or pt
Benefit of GI Emptying Before Charcoal?
- no- especially not if present late, are asymptomatic.
- Gastric emptying will not add benefit to charcoal
- Benefit of charcoal not even proven but is considered state of the art to give unless full absorption already occurred
Will Some Pts Benefit From Aggressive GI Decon?
- charcoal not useful for iron, lithium alcohol, caustics, hydrocarbons
- even with sustained release meds, if most of drug has moved beyond stomach, lavage will only hold up charcoal
- if pt given ipecac and vomits long time before ED presentation- probably don't need additional charcoal for pediatric pts
ED physician needs to evaluate each ingestions individually and design treatment plan. If substance poorly aborbed to charcoal- try gastric lavage unless have prolonged delay. Usually charcoal alone is best choice. If late presenting pt and asymptomatic- no gi decon needed. If ealy and symptomatic- personal choice to do gastric lavage followed by charcoal or just charcoal- examine relative risk.