Activated charcoal LAME

[JakeEMTP]

It seems as if your evaluator interpreted the scenario differently than you. If the pt. responds to verbal stimuli, they aren't unresponsive ( read semi or unconscious, remember AVPU? ) and have a patent airway so you could administer the activated charcoal in their opinion.

Unfortunately as a basic you do not have the ability to use a NG tube to administer activated charcoal which would elevate this problem,which sucks. Protecting the airway is key.

I haven't heard of the burnt toast thing. The charcoal is meant to absorb some of the toxins and I can't see how toast would have the same effect. However, I might subscribe to this theory if there was some evidence that it works rather than hearsay.

[tskstorm]

only 20second ? hehe like i said weve been lucky most of em take a nasty enough combo tht theyve puked already by the timw weve gottn there so we just hve to keep the airwy open til we get em to the er

I've never seen charcoal drank that didn't make a patient vomit. So we try to do it right before we get there if the opportunity permits.

[Dustdevil]

Rather than just altered LOC, it's altered LOC with inability to protect airway. It's obviously open to some interpretation.

Exactly. Sounds like the examiner may have done a poor job of painting a picture for this scenario. But its just as possible that you got tunnel visioned on the mental status thing, and let it distract you from the fact that the patient was fully capable of swallowing without aspirating. That is the important distinction to make. It doesn't matter if he isn't answering questions appropriately, or not at all. If he is conscious and alert and can swallow, he's a candidate.

In an urban system, I have never used charcoal in three decades of practice. I've used it in rural systems (and hospital practice, of course), but always directly through an NG tube, so airway wasn't a huge factor.

I'm surprised anybody's EMT course actually talked about burned toast. That's old skool Red Cross stuff. You've got to burn a LOT of toast to have any hope whatsoever of making a difference. And unless you have a toaster in your ambulance, you shouldn't be on a scene that long.

FEEDBACK?

Well, since you ask, yes. Spell Check is your friend.

[Richard B the EMT]

Syrup of Ipicac used to be in my protocols and has been removed, but a reminder for those who still have it in theirs: Ipicac causes vomiting. Do not use if whatever substance was swallowed caused burning on the way down, as it will cause burning on the way up.

Activated charcoal absorbs the poisons/toxins, until the ED can "pump" the solution out. Never use both methods at the same time, as the charcoal will prevent the ipicac from causing the patient to vomit the substances out.

As to indication or contraindication, if the option is available, call your on line medical control.

[steph1030]

I've never seen charcoal drank that didn't make a patient vomit. So we try to do it right before we get there if the opportunity permits.

i never sid the charcoal was administered therehave been a few occassions (mind you VERY FEW)where whatever they hve taken has made them vomit long BEFORE ems came onto scene therefore we just kept airway open and transported to the er

[AnthonyM83]

thank you. thats exactly what i wanted to hear. I had asked a paramedic friend of mine and he told me to never use activated charcoal on someone with an altered mental status as well as anything oral

How was he not responding to verbal stimuli? At all, like he was in a complete coma? Or was he just confused and not answering your questions? What was his GCS and ability to follow commands and protect his airway?

The answers you get are based on how you word your questions...let's make sure you're wording it right or you might get a false confirmation.

[Fluffpaw38]

The evaluator stated, "your patient responds in slurred speech". And when i sometimes asked him questions the evaluator said, "the patient does not respond, but only stairs off into space." So i had to get information from bystanders/family. Which they said he had taken a whole bottel of sleeping pills. The patient was also described as dizzy and tired.

[spenac]

The evaluator stated, "your patient responds in slurred speech". And when i sometimes asked him questions the evaluator said, "the patient does not respond, but only stairs off into space." So i had to get information from bystanders/family. Which they said he had taken a whole bottel of sleeping pills. The patient was also described as dizzy and tired.

With that info I would feel they were unable to protect their airway and so a basic would not administer anything orally.

[Fluffpaw38]

With that info I would feel they were unable to protect their airway and so a basic would not administer anything orally.

Thats exactly how i felt but there is a major difference between street EMS and being tested. And i think thats what the problem was...i was thinking in the field EMS, not testing.

[firedoc5]

This had been argued for a while in my system years ago. We came to an agreement that charcoal shall not be given orally, unless with NG tube. We had it available in the field, but I don't think it had been done. At least I never did it. One OD we had we were given the order to adm. Syrup of Ipecac. In the back ground we could hear the doc laughing over the radio. So we gave it. The doc didn't realize we had a short ETA, so it didn't really take effect until we got to the ER. We had it timed just right. When we got there I said, "Now the puking shall commence". About 90 seconds later, "up came chuck". :pukeright: :laughing6: