Packing/Stuffing

Packing – For a trip

  • CT is the only sufficiently sensitive screening test – can be without contrast unless need to identify bowel ischemia
  • Whole bowel irrigation
    • Start with 1.5-2L of Go Lytely (PEG-ELS) /hr and titrate for clear effluent
    • Continue until 2-3 packet free stools
    • Needs to be via NG or OG b/c too much to drink
  • If become symptomatic, evidence of obstruction or bowel ischemia standard supportive cares but need emergent surgical consult for emergent ex lap

Stuffing

  • Generally 6 hrs obs if asymptomatic
  • If abnml VS or symptoms need admission
  • Methamphetamine consider 24 hrs obs b/c higher risk of toxicity
  • Heroin generally become symptomatic w/in 1 hr if they are going to be – still rec 6 hr observation