Advertisement

A retrospective review of the prehospital use of activated charcoal

Published:October 21, 2014DOI:https://doi.org/10.1016/j.ajem.2014.10.019

      Abstract

      Objective

      We studied the complications and timing implications of prehospital activated charcoal (PAC). Appropriateness of PAC administration was also evaluated.

      Methods

      We retrospectively reviewed prehospital records over 32 months for overdose cases, where PAC was administered. Cases were assessed for amount and type of ingestant, clinical findings, timing of PAC, timing of transport and arrival into the emergency department (ED), and complications. Encounter duration in cases of PAC was compared with that, for all cases during the study period, where an overdose patient who did not receive activated charcoal was transported.

      Results

      Two thousand eight hundred forty-five total cases were identified. In 441 cases, PAC was given; and complications could be assessed. Two hundred eighty-one of these had complete information regarding timing of ingestion, activated charcoal administration, and transport. The average time between overdose and PAC was 49.8 minutes (range, 7-199 minutes; median, 41.0 minutes; SD, 30.4 minutes). Complications included emesis (7%), declining mental status (4%), declining blood pressure (0.4%), and declining oxygen saturation (0.4%). Four hundred seventeen cases of PAC had documentation of timing of emergency medical service (EMS) arrival on scene and arrival at the ED. Average EMS encounter time was 29 minutes (range, 10-53 minutes; median, 27.9 minutes). Two thousand forty-four poisoning patients were transported who did not receive PAC. The average EMS encounter time for this group was 28.1 minutes (range, 4-82 minutes; median, 27.3 minutes), not significantly different (P =.114).

      Conclusions

      Prehospital activated charcoal did not appear to markedly delay transport or arrival of overdose patients into the ED and was generally safe.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Neuvonen P.J.
        • Olkkola K.T.
        Oral activated charcoal in the treatment of intoxications: role of single and repeated doses.
        Med Toxicol. 1988; 3: 33-58
        • Chyka P.A.
        • Seger D.
        • Krenzelok E.P.
        • Vale J.A.
        Position paper: single-dose activated charcoal.
        Clin Toxicol. 2005; 43: 61-87
        • Tenenbein M.
        • Cohen S.
        • Sitar D.S.
        Efficacy of ipecac-induced emesis, orogastric lavage, and activated charcoal for acute drug overdose.
        Ann Emerg Med. 1987; 16: 838-841
        • Yeates P.J.
        • Thomas S.H.
        Effectiveness of delayed activated charcoal administration in simulated paracetamol (acetaminophen) overdose.
        Br J Clin Pharmacol. 2000; 49: 11-14
        • Green R.
        • Grierson R.
        • Sitar D.S.
        • Tenenbein M.
        How long after drug ingestion is activated charcoal still effective?.
        J Toxicol Clin Toxicol. 2001; 39: 601-605
        • Alaspää A.O.
        • Kuisma M.J.
        • Hoppu K.
        • Neuvonen P.J.
        Out-of-hospital administration of activated charcoal by emergency medical services.
        Ann Emerg Med. 2005; 452: 207-212
        • Isbister G.K.
        • Dawson A.H.
        • Whyte I.M.
        Feasibility of prehospital treatment with activated charcoal: who could we treat, who should we treat?.
        Emerg Med J. 2003; 20: 375-378
        • Watson W.A.
        • Litovitz T.L.
        • Rodgers G.C.
        • Klein-Schwartz W.
        • Reid N.
        • Youniss J.
        • et al.
        2004 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System.
        Am J Emerg Med. 2004; 23: 589-666
        • Kulig K.
        • Bar-Or D.
        • Cantrill S.V.
        • Rosen P.
        • Rumack B.H.
        Management of acutely poisoned patients without gastric emptying.
        Ann Emerg Med. 1985; 14: 562-567
        • Pond S.M.
        • Lewis-Driver D.J.
        • Williams G.M.
        • Green A.C.
        • Stevenson N.W.
        Gastric emptying in acute overdose: a prospective randomized controlled trial.
        Med J Aust. 1995; 163: 345-349
        • Merigian K.S.
        • Woodard M.
        • Hedges J.R.
        • Roberts J.R.
        • Stuebing R.
        • Rashkin M.C.
        Prospective evaluation of gastric emptying in the self-poisoned patient.
        Am J Emerg Med. 1990; 8: 479-483
        • Merigian K.
        • Blaho K.
        Single-dose activated charcoal in the treatment of the self-poisoned patient; a prospective, randomized, controlled trial.
        Am J Ther. 2002; 9: 301-308
        • Cooper G.M.
        • Le Couteur D.G.
        • Richardson D.
        • Buckley N.A.
        A randomized clinical trial of activated charcoal for the routine management of oral drug overdose.
        QJM. 2005; 98: 655-660
        • Boyd R.
        • Hanson J.
        Prospective single blinded randomised controlled trial of two orally administered activated charcoal preparations.
        J Accid Emerg Med. 1999; 16: 24-25
        • Minocha A.
        • Wiley S.H.
        • Chabbra D.R.
        Superior efficacy of sorbitol cathartics in poisoned patients.
        in: AAPCC/AACT/AMBT/CAPCC Annual Scientific Meeting, Santa Fe, New Mexico, September 25–30 1986b. 1986 ([Abstract 112])
        • Isbister G.K.
        • Downes F.
        • Sibbritt D.
        • Dawson A.H.
        • Whyte I.M.
        Aspiration pneumonitis in an overdose population: frequency, predictors, and outcomes.
        Crit Care Med. 2004; 32: 88-93
        • Crockett R.
        • Krishel S.J.
        • Manoguerra A.
        • Williams S.R.
        • Clark R.F.
        Prehospital use of activated charcoal: a pilot study.
        J Emerg Med. 1996; 14: 335-338
        • Manoguerra A.S.
        • Erdman A.R.
        • Woolf A.D.
        • Chyka P.A.
        • Caravati E.M.
        • Scharman E.J.
        • et al.
        Valproic acid poisoning: an evidence-based consensus guideline for out-of-hospital management.
        Clin Toxicol (Phila). 2008; 46: 661-676
        • Dart R.C.
        • Erdman A.R.
        • Olson K.R.
        • Christianson G.
        • Manoguerra A.S.
        • Chyka P.A.
        • et al.
        Acetaminophen poisoning: an evidence-based consensus guideline for out-of-hospital management.
        Clin Toxicol (Phila). 2006; 44: 1-18
        • Cobaugh D.J.
        • Erdman A.R.
        • Booze L.L.
        • Scharman E.J.
        • Christianson G.
        • Manoguerra A.S.
        • et al.
        Atypical antipsychotic medication poisoning: an evidence-based consensus guideline for out-of-hospital management.
        Clin Toxicol (Phila). 2007; 45: 918-942
        • Woolf A.D.
        • Erdman A.R.
        • Nelson L.S.
        • Caravati E.M.
        • Cobaugh D.J.
        • Booze L.L.
        • et al.
        Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management.
        Clin Toxicol (Phila). 2007; 45: 203-233
        • Nelson L.S.
        • Erdman A.R.
        • Booze L.L.
        • Cobaugh D.J.
        • Chyka P.A.
        • Woolf A.D.
        • et al.
        Selective serotonin reuptake inhibitor poisoning: an evidence-based consensus guideline for out-of-hospital management.
        Clin Toxicol (Phila). 2007; 45: 315-332
        • Olson K.R.
        • Erdman A.R.
        • Woolf A.D.
        • Scharman E.J.
        • Christianson G.
        • Caravati E.M.
        • et al.
        Calcium channel blocker ingestion: an evidence-based consensus guideline for out-of-hospital management.
        Clin Toxicol (Phila). 2005; 43: 797-822
        • Chyka P.A.
        • Erdman A.R.
        • Christianson G.
        • Wax P.M.
        • Booze L.L.
        • Manoguerra A.S.
        • et al.
        Salicylate poisoning: an evidence-based consensus guideline for out-of-hospital management.
        Clin Toxicol (Phila). 2007; 45: 95-131
        • Wax P.M.
        • Erdman A.R.
        • Chyka P.A.
        • Keyes D.C.
        • Caravati E.M.
        • Booze L.
        • et al.
        Beta-blocker ingestion: an evidence-based consensus guideline for out-of-hospital management.
        Clin Toxicol (Phila). 2005; 43: 131-146
        • Thakore S.
        • Murphy N.
        The potential role of prehospital administration of activated charcoal.
        Emerg Med J. 2002; 19: 63-65
        • Tuuri R.E.
        • Ryan L.M.
        • McCarter R.J.
        • Wright J.L.
        Does emergency medical services transport for pediatric ingestion decrease time to activated charcoal?.
        Prehosp Emerg Care. 2009; 13: 295-303