Summary
Gastrointestinal decontamination for acute medication poisoning: implementation of advanced triage for activated charcoal administration
Vernet D, García R, Plana S, Amigó M, Fernández F, Nogué S
Affiliation of the authors
Enfermería de Urgencias, Sección de Toxicología Clínica, Área de Urgencias, Hospital Clínic, Barcelona, Spain. Grupo de Investigación Urgencias: procesos y patologías, IDIBAPS, Barcelona, Spain.
DOI
Quote
Vernet D, García R, Plana S, Amigó M, Fernández F, Nogué S. Gastrointestinal decontamination for acute medication poisoning: implementation of advanced triage for activated charcoal administration. Emergencias. 2014;26:431-3
Summary
Objectives: To evaluate an advanced triage protocol for administering activated charcoal to decontaminate the digestive tract after acute medication poisoning. The protocol sought to reduce times from patient arrival to start of decontamination; the study sought to assess the effect of the protocol on clinical outcome.
Methods: Prospective study of cases of acute medication poisoning attended in the emergency department during 1 year. We designed an advanced triage protocol for nurse administration of activated charcoal to medication-poisoned
patients. The protocol took into consideration type of medication ingested, dose, time elapsed since ingestion, and neurologic evaluation of the patient. Time to start of care, side effects of activated charcoal use, and patient outcomes were assessed. We also collected the same information for a group of medication-poisoning cases treated in an earlier period.
Results: The protocol was applied to 68 patients. The average time from arrival in the emergency department until activated charcoal ingestion was 25 minutes. Charcoal was given within 20 minutes of arrival (the quality-of-care indicator) to 35.3% of the patients. Four patients vomited the charcoal slurry, but no bronchial aspiration occurred.
Times from door to charcoal ingestion and from poisoning to charcoal ingestion were shorter for the study patients than for the control patients; the quality-of-care indicator was also met more often in the study group (P<.001, all comparisons). No differences were observed in length of stay in the emergency department or destination on discharge. Conclusions: The triage protocol significantly reduced the time between arrival and treatment with activated charcoal, improving compliance with the quality-of-care indicator. The protocol did not reduce time spent in the emergency department or affect destination on discharge.