Ingestion - charcoal vs lavage vs induced emesis

Gastrointestinal decontamination

•  #1 activated charcoal, but can also do gastric lavage or induced emesis

Indications for gastric lavage:

• IF large amounts of life threatening meds were taken within one hour (the golden hour), then stuff hasn't passed through the pylorus yet
• IF charcoal will be inadequate
• May be effective a couple of hours after ingestion if an anticholinergic was ingested, because these drugs slow gut motility, and ingestions remain in the stomach longer.
• risks of gastric lavage: aspiration, mechanical trauma, bradycardia, physical restraint

Gastric emptying may be accomplished by lavage (above) or induced emesis (below)

• the only approved emetic is syrup of ipecac
• not usually recommended for home use in urban areas because they often get to the hospital soon enough for activated charcoal to be used; and ipecac also interferes with activated charcoal
• indicated often for plant ingestions in rural areas where it may be hours from a medical center
• contraindicated: caustics, hydrocarbons, uncontrolled HTN (i.e. ingest an adrenergic), increased ICP, issues of questionable airway (ie swallow benzo)