Activated Charcoal Use In The Field

[crotchitymedic1986]

Digging through some old posts on here, I came across a heated arguement over the use of charcoal (or lack thereof) in the field. I never gave it in the field, but most of my OD patients did get it in the ER, so maybe there is some arguement for greater use in the field (when indicated and not contraindicated). What do you guys think ?

[akroeze]

Don't carry it, never have.

[reaper]

Don't carry it anymore!

Only used twice in last 20 years and both times were a fight to get done.

[CBEMT]

Required BLS med here, never used it in the field, but one patient got it before they were off my stretcher at the ER. That was a psych patient though, so the hospital had some means of... negotiation, that I did not ("Drink it or you'll be restrained and get a tube down your nose").

[Arizonaffcep]

I've used it several times, all with fairly compliant pts who would end up drinking it on their own (with encouragement). But...it's affectiveness is low after about 30 min, when most things have been absorbed by the body. The big thing on using it vs. not in AZ is just the time frame involved.

[crotchitymedic1986]

So Arizona, in your humble opinion, is it something we should do more often. It seems we are always looking for the newest, latest treatment or skill that we can employ, but we have a cure in our drug box we never use. I never used it because it was just too damn messy, especially if they puked it back up (but i guess in hindsight, i could have let them drink it in their house before being put in the truck), but if I look at it strictly from what is best for the patient, it seems criminal to continue to allow toxic substances to be absorbed in the body, when i can stop it with something on my bus. That would be like denying D50 to a diabetic. The more i think about, the worse i feel about my lack of treatment for these patients.

[Richard B the EMT]

When I started in 1973, we were required to carry both activated charcoal, to slow or stop the poison absorption, and Ipecac, to induce vomiting. The standing instruction was, never use both at the same time, as one's effects would be countered by the effects of the other.

I have never used either, and my local protocols no longer allow carrying Ipecac.

[HellsBells]

We carry it here and I've used it about 4-5 times, never had any problems, no messy vomit, just pt complaints about the taste.

However, when I was with a rural service we had a pt with a multi-pharm OD, altered LOC and going down, we decided (quite appropriately in my opinion) not to use charcoal. We arrive at the hospital, give report to the nurse and she flipped out, demanding to know why we didn't give charcoal. So, with great difficulty she "assists" the pt in drinking some of the drug, which she promptly vomits back all over herself and the bed, and the nurse, and everything else in the general area.

[Arizonaffcep]

So Arizona, in your humble opinion, is it something we should do more often. It seems we are always looking for the newest, latest treatment or skill that we can employ, but we have a cure in our drug box we never use. I never used it because it was just too damn messy, especially if they puked it back up (but i guess in hindsight, i could have let them drink it in their house before being put in the truck), but if I look at it strictly from what is best for the patient, it seems criminal to continue to allow toxic substances to be absorbed in the body, when i can stop it with something on my bus. That would be like denying D50 to a diabetic. The more i think about, the worse i feel about my lack of treatment for these patients.

Yes and no. If the decision to not use it is based on a "I don't want to make a mess," then sack up and do it, if it will benefit your patient. If it's a decision based on a "s/he took xyz drug 60 minutes ago" and you know at this point, the drugs have already been absorbed, then it's a moot point, and not worth giving.

Keep in mind, with activated charcoal, time is the factor. Once the drug is out of the digestive system, it's fairly ineffective because it must come in CONTACT with the drug, in order to adsorb it.

[CBEMT]

I forgot to mention that the children's hospital that gave the charcoal mixed it with Coke before they gave it to our patient. How much more palatable that is I couldn't tell you.