Activated charcoal not so active anymore

[CoffeeInThatNebula]

Take it out and taste it... It wont hurt ya if you just taste a little, it's really not that bad...

The charcoal we got to look at in class was expired so I wasn't allowed...:sad:

We're still supposed to learn about activated charcoal since the book and exam still have it in there, but before I think we had to contact the MD in order to actually administer it.

I don't think it's possible, but I suggested that they just make charcoal taste like apples...or something...

 

[Veneficus]

CHarcoal for APAP OD? I've always been taught not to give it so the ED can give Mucamyst IV...

Really? I was always told mucamyst was basically long the lines of what to use when the timeline for charcol was past

 

[usafmedic45]

Ah....all the vials I've ever seen of the stuff state on it "Not for intravenous injection" and used to be it wasn't FDA approved in the US for that route. Never bothered to look into it further since it's not part of my job.

 

[zmedic]

Okay, couple of things:

There is pretty much no real evidence that activated charcoal prevents mortality. It makes sense theoretically but it hasn't really been born out in practice.

The reason is is going away is because if the person has taken something that reduces their level of conciousness and they aspirate the charcoal, it is very very bad. People have died of it, and often in cases where the ingestion itself probably wouldn't have killed them.

So you have a treatment of limited use, that can be very dangerous. Especially since the people who are at the greatest risk of dying (ie large ingestion, unconcious) are at the biggest risk.

Also a large number of ingestions won't kill people. Opioids? Give Narcan. Benzos? Intubate and wait. Tylenol? NAC. Caustics like acid? Don't give charcoal anyway.

So the question is what are these ingestions that you think this will make a difference?

Activated charcoal is only appropriate in my book for a recent ingestion of a potentially life threatening substance, in an awake and cooperative patient who you have low suspicion that they will have a deterioration in mental status. Which describes almost no one.

To N-Acytlcystien. You can give it IV or PO. PO tastes bad. Also even though PO is "cheaper" it's a much longer course. (I think PO is like a 72 hour course), where IV they can often be done in 21 hours. So the IV ends ip being cheaper overall because they spend less time in the hospital.

IV is better in my opinion because of that.

 

[Veneficus]

Activated charcoal is only appropriate in my book for a recent ingestion of a potentially life threatening substance, in an awake and cooperative patient who you have low suspicion that they will have a deterioration in mental status. Which describes almost no one.

The only people I have seen charcoal given to usually meet that description and are most commonly teenage female suicide attempts with a variety of various substances.

If not given as an NG lavage, they usually vomit immediately after drinking it from a cup and seem to feel better. (I would think most likely becase of the vomiting rather than the charcoal) But if you suction it out the NG, I stipulate at least the benefits of a lavage can be gained.

 

[zmedic]

I know people who advocate against putting it down the NG tube. It's a big mess, the patient is gagging. And they feel like you are at higher risk of aspirating once you start going with an NG tube.

They are also not big fans of the lavage.

 

[Veneficus]

I know people who advocate against putting it down the NG tube. It's a big mess,

Absolutely it is.

the patient is gagging. And they feel like you are at higher risk of aspirating once you start going with an NG tube.

That is what xylocaine is for. I swear, people in the US outside of anesthesia simply are too conservative to effectively chemically manage patients.

 

[jgmedic]

In Mass we have to contact medcon to administer activated charcoal. I think that the distance that the PT has to be transported to the hospital depends on whether or not the PT gets the shake or not. At least where I am by the time we contact medcon and administer the activated charcoal the PT could be at the ED.

It's BHO only here too. I've given it twice in my 2 years as a medic, both with prescription med OD's less than an hour PTA.

 

[xshellyx]

My partner and I gave charcoal to a teenage male OD on a call, kid downed it like a champ, and was even given a second one. He said it didn't taste bad at all....

 

[TreySpooner65]

We were going through general pharmacology in my EMT-B class today and my instructor informed us that the department is getting rid of activated charcoal. Is this something going on nationwide? I mean, I understand it's gross, but does anyone know why this is happening for any reason other than that? I would've thought they'd at least find a replacement for it, but apparently they haven't.

Once it's gone, what will be procedure for poisoned and OD patients? Just get 'em to the hospital as fast as possible?

We have charcoal. Ive heard its getting phased out but no word on whats coming in yet

 

[zmedic]

The procedure is going to be basic support of ABCs, monitor vital signs, and gather info at the scene (pill bottles, etc).

Not much specific antidotes that have to be done quickly, maybe bicarb for aspirin ODs but truth is we don't see many of those, they are hard to diagnosis in the field, and those people really need a bicarb drip, an amp of bicarb isn't going to do it.