II. Protocol: Gastric Decontamination
- Indications
- Severe ingestion cases as directed by poison control
- Gastric Decontamination is no longer recommended for most ingestions
- Techniques
III. Protocol: Skin Decontamination (e.g. chemical exposure)
- Remove all clothing (removes 70-90% of contaminants)
- Water Decontamination
- Wash skin with soap and water
- High volume dilution with tepid water is most effective
- Avoid cleaning with abrasives
- Water irrigation is contraindicated in the following exposures (risk of explosion)
- Other Precautions
- Oily substances such as polychlorinated biphenyls (PCBs) are not eliminated with water alone
- Water may increase the skin absorption of some contaminants ("rinse-in")
- Irrigation generates contaminated wastewater
- Dry Decontamination
- Materials
- Tissue paper, Incontinence pads, Wound Dressings
- Fuller's Earth (fine grained with hydrated aluminum silicates)
- Absorbs grease, fats and oils
- May apply prior to washing off with water
- Indications
- Water not readily available or contraindicated
- Concerns regarding increased absorption with water
- Concerns regarding contaminated waste water
- Materials
- Protect health care workers from exposure
- Use appropriate Personal Protective Equipment
- Example: Organophosphates on clothing
- Irrigate eye exposures with Normal Saline or water (e.g. eye wash station)
IV. Protocol: Enhancement of Elimination
- See Urinary Alkalinization for Indications
- Contraindicated or ineffective measures
- Acidification
- Forced Diuresis
V. Protocol: Blood filtering
- See Hemodialysis for Indications
- Charcoal Hemoperfusion Indications
VI. References
- Kinker and Glauser (2021) Crit Dec Emerg Med 35(9): 19-27
- Chu (2002) Am J Respir Crit Care Med 166(1):9-15 [PubMed]
- Erickson (2007) Emerg Med Clin North Am 25(2):249-81 [PubMed]
- Mokhlesi (2003) Chest 123(2):577-92 [PubMed]
- Nicholson (1983) Med Clin North Am 67(6):1279-93 [PubMed]
- Jones (2002) Ther Drug Monit 24(1):150-5 [PubMed]