Special Operations Forces Medical Handbook

5-142

20 minutes of ingestion), gastric lavage, and/or activated charcoal to minimize toxins in the GI tract (see
below).
NOTE: Inducing diarrhea is NOT effective and is likely to make the patient worse (dehydration, uid/electrolyte
imbalance).

Syrup of ipecac - effective in some cases if administered within 20 minutes of ingestion.

1. Administration:
   a. In patients 1-12 years old, give 15 ml followed by 2-3 glasses of water.
   b. In patients over 12 years, give 30 ml followed by 2-3 glasses of water.
   b. May be repeated in 20 minutes if vomiting does not occur.


2. Complications: Mallory-Weiss tear of the esophagus, causing bleeding; pneumomediastinum (air trapped
   in chest cavity outside the lungs); diaphragmatic or gastric rupture; and/or aspiration pneumonitis


3. Contraindications: Patient < 1 year old, altered level of consciousness (aspiration), ingestion of caustic
   substances, loss of gag reflex, seizures, pregnancy, acute myocardial infarction, ingestion of: acids,
   alkalis, ammonia, petroleum distillates, non-toxic agents, rapidly acting central nervous system agents,
   or hydrocarbons.
   Gastric lavage - may provide opportunity for immediate recovery of a portion of gastric contents.


4. Administration:
   A. Use large-bore orogastric tube rather than a smaller nasogastric tube (Size 36-40 French for adults,
   size 24-28 French for children).
   B. Never insert large orogastric tubes nasally (may fracture/amputate nasal turbinate and/or cause
   serious bleeding).


5. Complications: Agitation, tracheal intubation, esophageal perforation, aspiration pneumonitis, pediatric
   fluid and electrolyte imbalances.


6. Contraindications: Altered levels of consciousness (relative contraindication if the airway is protected),
   low-viscosity hydrocarbons or caustic agent ingestion.
   Activated charcoal


7. Administration
   a. Administering 20-30 minutes before gastric lavage may double the effectiveness of lavage.
   b. Do not administer until after vomiting if ipecac has already been given.
   c. Form slurry of 1-2 g/kg body weight (30-100 g for adults, 15-30 g for children), and
   administered orally or by gastric tube.


8. INDICATIONS/ CONTRAINDICATIONS:
   a. Safe and effective treatment in most toxic ingestions.
   b. Do not use for strong acid, strong alkali.
   c. Not effective for cyanide, iron or alcohol

Patient Education
Prevention and Hygiene: In cases of toddler poisonings educate mother/father regarding “poison proong” of
home. Remove all cleaning products and other toxins from child’s reach; apply locks to cabinet doors, etc.

Follow-up Actions
Evacuation/Consultation Criteria: Evacuate if patient unstable. If there is any question as to the severity
of the poisoning or whether the patient may have been committing an act of self harm, consult emergency
medicine/toxicology if patient unstable or serious poisoning suspected and psychiatry if poisoning is felt to
have been an act of self-harm.

Toxicology: Venomous Snake Bite

COL Clifford Cloonan, MC, USA

Introduction: Venomous snakes cause injuries and deaths worldwide in all temperate and tropical climates,
but they are a particular problem in Australia, which has 40% of the world’s neurotoxic snakes and about 23%
of all venomous snakes. In North America, poisonous snakes cause only 14-20 deaths per year. The risk of