Module 1: Introduction to GI Decontamination

1.1 Overview of Course Structure and Key Topics

This course will provide a comprehensive review of current best practices and evidence-based guidelines for gastrointestinal (GI) decontamination after ingestions of toxins, drugs, or foreign bodies. The content is designed to empower clinicians with the knowledge to selectively utilize GI decontamination modalities when indicated while avoiding unnecessary or harmful interventions.

The course is organized into 7 modules:

• Module 1 introduces the relevance and objectives of the course.

• Module 2 details the mechanisms and administration processes for activated charcoal, gastric lavage, and whole bowel irrigation.

• Module 3 covers clinical considerations in applying GI decontamination based on the toxin characteristics and patient presentation.

• Module 4 examines professional protocols and position statements that guide appropriate use of GI decontamination.

• Module 5 discusses illustrative case studies to reinforce key learning points.

• Module 6 summarizes the key takeaways from the course.

• Module 7 assesses knowledge through interactive quiz questions and elicits learner feedback.

By the end of the course, clinicians will be able to compare GI decontamination modalities, identify clinical situations warranting their use, demonstrate safe administration, and apply protocols for common ingestions.

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1.2 Background on GI Decontamination

GI decontamination refers to a range of techniques that aim to decrease absorption or enhance elimination of toxins from the gastrointestinal tract after ingestion. Potential benefits of GI decontamination include reducing systemic toxicity, mitigating target organ damage, and shortening clinical course. However, the interventions also carry risks such as aspiration, fluid/electrolyte shifts, bowel perforation, and patient discomfort.

Therefore, the decision to pursue GI decontamination requires careful consideration of the patient presentation, toxin characteristics, time since ingestion, and risks versus benefits of the procedure. Traditionally, gastric emptying techniques like gastric lavage were used more liberally. But updated guidelines recommend more selective use of GI decontamination based on clinical evidence and patient-specific factors.

Common modalities for GI decontamination include:

• Activated charcoal – adsorbent that binds toxins in the GI tract
• Gastric lavage – flushes stomach contents using a nasogastric tube
• Whole bowel irrigation – cleanses entire GI tract with polyethylene glycol solutions
• Cathartics – increase motility to eliminate bound toxins

These methods vary in their efficacy, timing, administration, risks, and clinical applications. This course will explore all aspects of GI decontamination to guide proper use in overdose and ingestion cases.

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1.3 Relevance to Emergency Medicine and Toxicology

GI decontamination strategies are often initiated in the emergency department setting. Patients may present following intentional or unintentional overdoses, adverse reactions from legitimate prescription use, unsupervised ingestions by children, or ingestion of foreign bodies.

Emergency clinicians must quickly assess the likely toxins involved, patient stability, time elapsed since ingestion, and anticipated toxicity. These factors all influence whether pursuit of GI decontamination is indicated and which modality is most appropriate. Having clear procedures and protocols aids in rapidly implementing GI decontamination in suitable candidates.

Clinical toxicologists likewise need to remain up-to-date on the evidence surrounding GI decontamination techniques. Toxicology consult services guide frontline providers on optimal interventions for poisoning cases. They also spearhead institutional protocols and clinical decision support tools on GI decontamination.

Ultimately this course aims to prepare emergency medicine providers, toxicologists, critical care specialists, and other clinicians to make judicious use of GI decontamination guided by the clinical context and individual patient presentation.