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ECG abnormalities consistent with significant ingestion:
Ventricular or supraventricular tachyarrhythmias
Sinus tachycardia > 140 / min
2nd or 3rd degree heart block
QT-prolongation (preferably index QTc)
QRS duration > 0.12ms
The place of gastric Lavage in acute poisoning is debatable, and is only of benefit in the hyper acute phase of poisoning (< 1 hour).
Patients must have intact level of consciousness and a preserved gag reflex, failing which the risks and benefits of intubating the patient need to be considered.
Insert 16G nasogastric tube (not a large bore sump)
Instil 1 ml/kg warm water only, then attempt recovery of the Lavage
Do not continue to instil water until the previous volume has been removed
Continue until Lavage is clear
Charcoal aspiration has a high morbidity and mortality. As for gastric Lavage above, this should not be attempted in patients without a safe or protected airway.
Instil 50g as soon as possible and 50g 4 hrly thereafter while indication persists. Co-administration with sorbitol has not been shown to increase effacy.
In general charcoal should be given in a ratio of 10:1, charcoal dose to drug ingested dose.
Virtually all patients presenting with a drug overdose.
Elemental metals (lithium, iron)
Strong acids or alkalis
Late presentations > 4-6 hrs post ingestion
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