Emergency Medicine Book

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Decontamination After Toxin Exposure

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

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