TOXICOLOGY
Induced emesis has largely been abandoned in clinical practice. The most
recent policy statements released by both the American Academy of Pedi-
atrics (2003) and the American Association of Poison Control Centers (2005)
discourage the use of syrup of ipecac in the out-of-hospital setting.DOSE
■ Suggested doses are 30 mL for adults, 15 mL for children 1–12 years old.
If no vomiting occurs by 30 minutes, the initial dose may be repeated.
■ Children 6–12 months old should receive a single, 10-mL dose.INDICATIONS
■ Ingestion of a substance with high toxic potential and:
■ Within 1 hour of ingestion
■ No other forms of GI decontamination are available or effective for the
given substance.
■ Potential benefits outweigh risks.CONTRAINDICATIONS
■ Substances not meeting above indications
■ Spontaneous emesis
■ Diminished level of consciousness/unprotected airway reflexes
■ Ingestion of hydrocarbons or caustic agents
■ Foreign body ingestion
■ Patient requires therapy by PO route, such as activated charcoal.Gastric LavageGastric lavage (GL) attempts to directly remove stomach contents by means
of an orogastric tube.INDICATIONS
■ Ingestion of a substance with high toxic potential and:
■ Within 1 hour of ingestion
■ Ingested substance is not bound by activated charcoal or has no effec-
tive antidote.
■ Potential benefits outweigh risks.CONTRAINDICATIONS
■ Substance not meeting above indications
■ Spontaneous emesis
■ Diminished level of consciousness/unprotected airway reflexes (intubate first)
■ Ingestion of hydrocarbons or caustic agents
■ Foreign body ingestion
■ Patient is at high risk for esophageal or gastric injury (GI hemorrhage,
recent surgery, etc.).TECHNIQUE
■ Recommended tube size is 36–40 French for adults, 22–28 French for
children.
■ Secure airway via intubation, if necessary.
■ Position patient in left-lateral decubitus position, with head lowered below
level of feet.