? Charcoal Aspiration?

We had an incident once where it was given and patient aspirated it. Pt got horrible chemical pneumonitis from it...was really sick for quite a while...did survive though and ended up doing fine...

I had a guy last night who puked all his charcoal up while lethargic. Of course I am now concerned about him developing ards.

In any event, have any of you had this happen to your patients? In 18 years, this was a first. People have vomitted the charcoal up before, but they weren't as lethargic as this guy was when it happened.

In the past, I even refused to give charcoal until the cxray confirmed the ngt placement to avoid such a problem.

Thanks for your input!

never waited for a cxr but i have always been taught that charcoal is contraindicated in lethargic or obtunded patients. :)

Yes, I've seen it happen. Didn't turn out well.

Poison control centers are recommending it less and less because its risk-benefit ratio is so narrow in many clinical situations. I am hoping your pt took bottles of tylenol (or something just as hepatotoxic) and poison control insisted it be given!

Has anyone ever given an o/d pt their charcoal, either thru an ngt or by mouth, only to have them doze off and then vomit it all over themselves and even aspirate it because of their decreased loc?

I had a guy last night who puked all his charcoal up while lethargic. Of course I am now concerned about him developing ards.

We suctioned him orally and nasaly, waited for him to stop, and then paralyzed him and intubated him. He even got loads of it in his eyes! He had a decent amount of charcoal come up with the in line suction. Peep was added to his vent settings. We then irrigated his eyes with saline and gave him unasyn. The resp tech wanted to pulmonary toilet him, but I really felt that if it was just in his trach and main stem bronci at that time, we'd be better off not pushing it down any farther, and just suction him frequently.

In any event, have any of you had this happen to your patients? In 18 years, this was a first. People have vomitted the charcoal up before, but they weren't as lethargic as this guy was when it happened.

In the past, I even refused to give charcoal until the cxray confirmed the ngt placement to avoid such a problem.

Thanks for your input!

I know that trying to intubate after vomiting charcoal is hard as heck, white vocal cords (and everything else) are now black!!!

Humorous story from remote past.

ER nurse places an NG tube to give charcoal. Does not realize (for whatever reason) that NG is actually in airway. Patient gets most of a 50gm bottle direct to mainstem bronchi.

Nurse later wonders why chest x-ray shows all white instead of the black she expected from charcoal. (TRUE STORY)

ER nurse places an NG tube to give charcoal. Does not realize (for whatever reason) that NG is actually in airway. Patient gets most of a 50gm bottle direct to mainstem bronchi.

Not funny for the patient!!

Nurse later wonders why chest x-ray shows all white instead of the black she expected from charcoal. (TRUE STORY)

Funny, but pretty darn scary to think that someone could be that retarded!!

I guess thats one of the reasons charcoal is on its way out. RE a Tylenol OD one has to weigh the benefit of the charcoal vs its absorbing the antidote Mycomyst, esp if one has to give it fairly close together.

As far as the NG in the wrong place fortunately that seems tobe going out of style. Have seen some information that the NG lavage actually breaks up clumps of pills and causes increased absorbtion.

My opinion is if they are not awake to drink it. or they have taken something that can make them sleepy they should not be getting it at all.

Rj

I guess thats one of the reasons charcoal is on its way out. RE a Tylenol OD one has to weigh the benefit of the charcoal vs its absorbing the antidote Mycomyst, esp if one has to give it fairly close together.

As far as the NG in the wrong place fortunately that seems tobe going out of style. Have seen some information that the NG lavage actually breaks up clumps of pills and causes increased absorbtion.

My opinion is if they are not awake to drink it. or they have taken something that can make them sleepy they should not be getting it at all.

Rj

We only give charcoal for tylenol OD if we know the ingestion was within 2 hours...we don't give oral mucamyst anymore either..thank god..we do IV NAC...we still EWALD every now and again...we had a lopressor OD not that long ago ingestion was 30 min PTA and got a significant amount of pills out...Pt took something near 60-80 pills...I'm not a big fan of charcoal down the NGT if I don't need to...we really way the pros and cons of giving it and consider how long ago ingestion was before we give it...

Just curious how your hospital justifies the cost difference. The one ER I worked that had the IV (Acetadote) form but only wanted us to use it in very rare circumstances. The cost is something like $400 vs $20, esp since sadly more often than not the patient has no medical insurance.

Rj

We only give charcoal for tylenol OD if we know the ingestion was within 2 hours...we don't give oral mucamyst anymore either..thank god..we do IV NAC...we still EWALD every now and again...we had a lopressor OD not that long ago ingestion was 30 min PTA and got a significant amount of pills out...Pt took something near 60-80 pills...I'm not a big fan of charcoal down the NGT if I don't need to...we really way the pros and cons of giving it and consider how long ago ingestion was before we give it...

Just curious how your hospital justifies the cost difference. The one ER I worked that had the IV (Acetadote) form but only wanted us to use it in very rare circumstances. The cost is something like $400 vs $20, esp since sadly more often than not the patient has no medical insurance.

Rj

I'm sure if we had a tylenol OD every night it would be a different story...we don't, not every tylenol OD is significant enough to require any NAC at all...so we are very nomagram dependant...The oral regimen is usually a 72 hour regimen, where the IV is usually a 20 hour regimen...And on another note...if they have any symptomatolgy at all from the OD, it is usually GI symptoms...so already being nauseous and vomiting and then having to drink something that smells like rotten eggs no matter what you mix it in....makes the potential to not get full doses in because of their inability to keep it down....so with length of hospital stays, and inability to orally tolerate plus the number of doses and cost is all taken into consideration when we give it...thats how we justify giving it...I give it at the hospital I work at now, as well as the hospital I was last at. The previous hospital I worked at, our Director was a toxicologist and the head of a toxicology program, so we went with his recommendations...As far as I know the IV version is still not approved by the FDA, and still considered experimental but we've been doing it for a quite a while....