1) Decontamination refers to practices that limit or minimize a patient's exposure to a ingested toxin. This includes removing clothing with skin contamination, flushing eyes or rinsing skin. 2) Common decontamination methods for ingested poisons include gastric lavage, whole bowel irrigation, and enhanced elimination techniques like hemodialysis or hemoperfusion. 3) Gastric lavage and whole bowel irrigation are controversial and their use is declining, as they carry risks and may not improve outcomes. They are generally only used for significant toxin ingestions that have not been absorbed.

1. First Aid & Decontamination
DR RAJESH K
ASST PROF & INCHARGE
DEPT OF EM
SRI DEVARAJ URS MEDICAL COLLEGE,KOLAR

2. Welcome All to virtual EM Andhra 2021

3. Best wishes to all the real hero @
crucial exigency of covid pandemic

4. “Poison is everything, and no thing is without
poison, the dosage makes it either a poison or
a remedy “ paracelsus

5. History of poison
• The history of poison stretches from before 4500
BCE to the present day.
• Poisons have been used for many purposes across
the span of human existence
•
Indian surgeon Sushruta defined the stages of
slow poisoning and the remedies of slow
poisoning

6. History of poison
• Today, poison is used for a wider variety of
purposes than it used to be.
• Pesticides: have known to be used in some form
since about 2500 BC.
• The use of pesticides has increased staggeringly
from 1950, and presently approximately
2.5 million tons of industrial pesticides are used
each year.

7. Statistics
• The NCRB recorded 133,623 deaths from suicide
in 2015 , of which 23,930 (17.9%) were due to
pesticides.
• 1995 to 2015, there were 2,451,410 suicides from
all methods and 441,918 pesticide suicides
(18.0% of the total) recorded in India.
• Maharashtra, Andhra Pradesh, Madhya Pradesh,
Tamil Nadu, West Bengal, Kerala, Telangana,
Karnataka, Gujarat, Odisha and Chhattisgarh.

8. Statistics
• States account for approximately 54.1% of the
total population of India, and 84.2% of suicides
by all methods in India.
• In 2015, The Anupam Verma Committee to
review the continued use of 66 pesticides that
have been banned or restricted for farming use in
other countries.
• In 2016, it recommended a ban on 13 pesticides,
phasing out of 6 pesticides by 2020,

9. Prehospital Care Of Firstaid
• Pre hospital care of someone who may have
been poisoned depends on:
• The person's symptoms
• The person's age and body weight
• Whether you know the type and amount of
the substance that caused poisoning

10. When to suspect poisoning
• Poisoning signs and symptoms can mimic various
clinical conditions…
• Burns or redness around the mouth and lips
• Breath that smells like chemicals, such as gasoline
or paint thinner
• Vomiting
• Difficulty breathing
• Drowsiness
• Confusion or altered mental status

11. What to do while waiting for help
• Swallowed poison: Remove anything remaining in the person's
mouth.
• Poison on the skin: Remove any contaminated clothing.
• Poison in the eye: Gently flush the eye with cool or lukewarm.
• Inhaled poison: Get the person into fresh air .
• If possible collect: pill bottles, packages or containers with labels
about the poison to send along with the ambulance team.

12. National Poison Information Centre
(24x7)
• 011 26589391
• 011 26593677
• Toll free number: 1800116117

13. Decontamination
• Decontamination refers to practice of limiting or
minimizing the exposure of a patient to a
ingested toxin.
• Benefits of Decontamination:
A. Prevention of further exposure
B. Prevention of secondary contamination
C. Prevention of contamination of the health care
facility.

14. Decontamination
• Decontamination efforts are initiated by first
responders, including HAZMAT teams.
• The managing patients with HAZMAT are to
protect the health care providers.
• The level of PPE is classified according to
Environmental protection agency A to Z.

15. Types of decontamination
• Many approaches have been adopted
• Gastric Evacuation
1. Gastric Lavage
2. Intra Gastric Binding
3. Whole Bowel Irrigation
• Enhanced Elimation
1. Hemodialysis
2. Hemoperfusion
3. Hempfiltration

16. Gastric Decontamination
• GI decontamination is a highly controversial
issue in medical toxicology.
• In 1997 Publication of position statement
lavage/induced emesis/WBI by AACT and
EAPCCT.
• The overall trend in decontamination is
continually declining.

17. OGL is done to remove substantial toxin
before absorption or diminish its efforts.
• INDICATIONS
a) Significant amount of toxin in GI tract.
b) Ingested toxin non absorbable.
c) Toxin exceeds the absorbable quantity.
d) No known contraindications.

18. Contraindications
• Doesn’t meet criteria for lavage.
• Risk of airway protection.
• Toxin with higher aspirational protection.
• Ingestion of alkaline caustic.
• Ingestion of foreign body
• Risk of perforation because of underlying
pathology/medical condition.

19. Technique of OGL
• Select correct tube size
• Check airway patency
• Better keep patient in left lateral decubitus
position.
• Proper length of tube to inserted and confirm
the position.
• In adults 250ml and children 10-15ml to max
of 250 ml.

20. Whole Bowel Irrigation
• A method of purging the GI tract in an attempt
to expeditiously achieve gut clearence to
prevent further absorption of toxin.
• No new evidence in position papers on WBI.
• Cant be done if the GI tract is adynamic or
obstructive ileus.

21. WBI remain theoretical because the only support for efficacy
comes from surrogate markers and anecdotal experience
Indications
• Toxins ingestion of
sustained release.
• Toxic amount of toxin not
adsorbed to AC.
• Removal of ilicit drug
packets from body packers.
Contraindications
• Absent airway reflexes.
• GI tract is not intact.
• Persistent vomiting.
• Signs of leakage from
cocaine packets.

22. Decontamination
• Dermal exposure.
• Ophthalmic exposure.
• Inhalational exposure.

23. Enhancing elimination
• Metal chelators.
• Resins
• Hemodialysis
• Hemofiltration
• Hemoperfusion
• Liver support devices
• Plasmapheresis.

24. General Indications
• Patients who fail to respond to comprehensive supportive care.
• Patients in whom the normal route of elimination is impaired.
• Patients in whom the amount of toxin absorbed or its high
concentration in serum indicates that seriously ill.
• Patients with concurrent disease.
• Paitents with concomitant electrolyte disorders that can be
corrected by hemodialysis.

25. References
• Goldfrank’s Toxicologic Emergencies 11E.
• mayoclinic .org
• www.Uptodate.com

27. Thanks EM ANDHRA for opportunity