| A | B |
|---|
| first line procedure for poison ingestion | emetics |
| emetics are usually given within * hours of ingestion of most substances | 4 hours |
| emetics can be given within 12 hours of ingestion of *** | Salicylates, anticholinergic agents, phenytoin |
| ingested substance where induction of vomiting -> seisures | convulsants |
| recommended by AAP in all homes with young children | ipecac |
| ingested substance where induction of vomiting -> chemical pheumonitis | hydrocarbons |
| ingested substance where induction of vomiting -> destroy esophageal tissue again | corrosive acid or alkali |
| TQ! ingested substances where vomiting should not be induced | convulsants, hydrocarbons, corrosive acid/alkali, sharp objects, nontoxic subs. |
| TQ! pts. that should not have vomiting induced | coma, dimin. gag reflex, severe CV ds., emphysema, weak BV, recent surgery, cirrhosis, varices, thrombocytopenia, <6mo old, signif. vomit already |
| TQ! early phase emesis w/ ipecac | within 30 min |
| TQ! mechanism of early phase emesis w/ ipecac and soap soln. | stim. of GI tract |
| TQ! late phase emesis w/ ipecac | after 30 min. |
| TQ! mechanism of late phase of emesis w/ ipecac and apomorphine | stim of the chemoreceptor trigger zone (vomiting center) |
| TQ! recommended dose of ipecac for 6-12mo old | 5-10 mL |
| TQ! recommended dose of ipecac for 1-12 yrs | 15 mL |
| recommended dose of ipecac for adults | 30 mL |
| second dose of ipecac | 20-30 min., if pt. fails to vomit |
| avg time to vomit w/ ipecac | 24 min. |
| Adverse with ipecac | diarrhea, lethargy, fever, protracted vomiting |
| chronic abuse of ipecac (anorexia nervosa and bulemia) | fatal cardiomyopathies |
| emetics other than ipecac | apomorphine, soap solution, mechanical stim. |
| time of onset for apomorphine | 3-5 min |
| form of emesis that lacks effectiveness | mechanical stim. |
| ways to decrease absorbtion | gastric lavage, dilution, emesis, activated charcoal |
| method to dec. abs. that is for most chems. and household items | dilution |
| what is used to dilute poisons? | water |
| mechanism of action with dilution | helps reduce gastric irritation, adds bulk for emesis later |
| recommended amount dilution for child | 1-2 cupfuls |
| recommended amt of dilution for adult | 2-3 cupfuls |
| process of washing out the stomach with solutions by a tube inserted thru nose or mouth | gastric lavage |
| solutions used for gastric lavage | saline/water, sodium bicarb, calcium salts, tannic acid, potassium permanganate |
| TQ! indications for gastric lavage | semiconcious, unconcious, loss of gag reflex, ipecac ineffective or contra, concious w/ lg. ingestion |
| TQ! contraindications for gastric lavage | corrosives, petroleum distillates, seizures |
| correct lavage needs | protected airway, L lat. decubitus position, largest tube diameter |
| aliquots for childrens lavage | 50-100 mL |
| aliquots for adult lavage | 200-300 mL |
| TQ? minimum required to wash out most of the stomach contents | 2 liters |
| gastric lavage is not effective against | bezoar |
| time frame for efficacy of gastric lavage | >2 hrs., up to 9-27 hrs. |
| reduces absorbtion of wide variety of poisons by absorbing the poison | activated charcoal |
| TQ! activ. charcoal useful in multiple doses | carbamazepine, digitoxin, theophylline |
| TQ! recommended dose of activated charcoal for adults | 50-100 grams |
| TQ! recommended dose of activated charcoal for children | 25-50 grams |
| TQ! recommended dose of activated charcoal for infants | 1 gram per kilogram |
| characteristics for activated charcoal to be effective | 1)particle size & lg. surface area, and 2)low mineral content |
| time interval for activated charcoal | within 30 min of ingestion; 6-8 hr if delayed emptying |
| indication that gastric lavage is comleted | contents of stomach run clear; and have used a min. of 2L of solution |
| dilution method is not good for *** | ingestion of tablets and capsules (solid dosage forms) |
