Gastrointestinal decontamination in the acutely poisoned patient

Albertson, Timothy E; Owen, Kelly P.; Sutter, Mark E.; Chan, Andrew

doi:10.1186/1865-1380-4-65

Cited by 43 publications

(22 citation statements)

References 151 publications

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“…This finding is consistent with the result of a previous study of poisoning in Palestine that showed among the cases which had undergone a decontamination procedure, GL was the most commonly used [3]. Use of other decontamination resources, besides GL, which is assumed to be still commonly practiced in the surveyed hospitals of this study, was consistent with the common practices recommended in the clinical literature [32-35], which support the limited use of all types of GI decontamination of acutely poisoned patients. Decontamination of severely poisoned patients must only be undertaken after careful consideration of the potential risks and benefits of the decontamination practice [34-37].…”

Section: Discussionsupporting

confidence: 92%

Availability of treatment resources for the management of acute toxic exposures and poisonings in emergency departments among various types of hospitals in Palestine: a cross-sectional study

Zyoud

Al-Jabi

Bali

et al. 2014

Scand J Trauma Resusc Emerg Med

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BackgroundPoisoning exposures continue to be a significant cause of morbidity and mortality worldwide. The lack of facilities, treatment resources, and antidotes in hospitals may affect the treatments provided and outcomes. This study aimed to determine the availability of gastrointestinal (GI) decontamination, stabilisation, elimination enhancement resources, and antidotes for the management of acute toxic exposures and poisonings in emergency departments (EDs) among various types of governmental and private hospitals in Palestine.MethodsA cross-sectional study using semi-structured questionnaire was performed. Data were collected based on hospital resources; GI decontamination, stabilisation, elimination enhancement resources and antidotes from Palestinian hospitals.ResultsEighteen hospitals (94.7%) have responded. Among them, paracetamol poisoning was the most frequently reported cases by EDs (mean frequency score = 7.6 ± 2.1), followed by bee stings (mean = 6.9 ± 2.7) and organophosphate poisoning (mean = 6.7 ± 2.7). The availabilities of most resources related to GI decontamination items varied substantially with hospital type, but these differences were not statistical significant. The availability of stabilisation resources was not significantly different between hospitals types. For the availability of techniques used to enhance the elimination of toxic substances, there were variations between the hospitals types. However, these differences were not statistical significant, except for haemodialysis (p = 0.003) which was more available in governmental hospitals. For the availability of antidotes, none of the hospitals had sufficient stock of all antidotes listed. In relation to hospital type, there was variability in the availability of antidotes, but this did not reach statistical significance, except for deferoxamine (p < 0.001), which was available in all governmental hospitals but none of the private hospitals.ConclusionsThe availability of treatment resources and antidotes in Palestinian hospitals was not adequate except for stabilisation resources. The availability of such resources acts as a marker for the level of readiness of hospital EDs in Palestine for the management of acute toxic exposure and poisoning. The implementation of a minimum list of antidotes and treatment resources would be useful to increase the level of resources. Coordination between Palestinian poison control and drug information centre and hospitals is also important.

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Section: Discussionsupporting

confidence: 92%

Availability of treatment resources for the management of acute toxic exposures and poisonings in emergency departments among various types of hospitals in Palestine: a cross-sectional study

Zyoud

Al-Jabi

Bali

et al. 2014

Scand J Trauma Resusc Emerg Med

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“…In practice this suggestion is not always followed. Another example is the use of activated charcoal which appears to be mostefficacious when given within an hour of ingestion (28), and other studies reported gastric lavageis usually not helpful beyond 4 hours of ingestion(29) but both of them were not followed in the present study. Irrespective of the time, gastric lavage is performed in this hospital, as the initial part of treatment.…”

Section: Discussioncontrasting

confidence: 46%

Pattern of acute poisoning in teaching hospital, northwest Ethiopia

Adinew

Asrie

2016

IJPT

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Background: Acute poisoning is considered a major health problem worldwide and is a frequent cause of hospital admission. It is estimated that poisons are responsible for more than 1 million illnesses worldwide annually. Objective: To evaluate retrospectively the pattern of acute poisoning in teaching hospital, northwest Ethiopia. Materials and methods:This was an observational, retrospective study. The study population includes all patients who visiting Gondar teaching hospital emergency room who were diagnosed with acute poisoning from September 2010 to December 2014. All data were analyzed using SPSS 20. Result: Acute poisoning cases constituted 0.67% of the 34320 admissions to the emergency department. Of these 233 patients, 148 (63.5%) were female and 85 (36.5%) were male.88.42% were younger than 30 years of age and the frequency of acute poisoning declined with advanced age. Organophosphates were the most frequent cause of poisoning and accounted for 89 cases (38.2%). Intentional poisoning comprised 57.5 %.83.6 %( 195 cases) of the cases were ingested orally, the mean arrival time to the emergency unit after poisoning was 4.2 hours and the average duration of hospital stay was 11.26hours. It was found that 60 % of the cases were simply received supportive therapy. The most common factors contributing to intentional poisoning was quarreled with their family (54.2%) followed by love affairs (18.4%). The mortality rate was 0.43% Conclusions: The data observed in this hospital based shows acute poisoning remains a major public health problem with pesticide poisoning remaining the most common and therefore concerning poison.

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“…30 Serious risks of the procedure include aspiration pneumonia, arrhythmia, fluid and electrolyte abnormalities, hypoxia, laryngospasm, and perforation of the GI tract or pharynx. 31 Availability of other decontamination resources besides gastric lavage in this study was not high, which is consistent with common practices recommended in the clinical literature, [31][32][33][34][35] which support the limited use of all types of GI decontamination in acutely poisoned patients.…”

Section: Discussionsupporting

confidence: 85%

The mastery of antidotes

et al. 2016

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Aim: To describe various types of Chinese hospitals’ emergency department (ED) physicians’ knowledge of antidotes and the comparative availability of toxicological treatments at these hospitals. Methods: We emailed a written survey to the ED doctors of 900 hospitals in China. The hospitals’ names and addresses were obtained and randomly selected from the 6214 hospitals registered by the Chinese Medical Association. The survey included 23 questions on antidotes to commonly seen poisonings as well as questions on the availability of antidotes and decontamination techniques at each hospital. Results: Six hundred and fifty three hospital emergency directors responded to the survey 72.6% response rate). Overall knowledge of antidotes is not high and varied depending on antidote. Physicians in Eastern China, those working in tertiary-level hospitals and those working in hospitals with higher numbers of beds performed significantly better. On average, only 35.6% of the 23 antidotes were available in all reporting hospitals; 54.1% can get these antidotes from nearby hospitals and 42.0% can get them from a local CDC poison control center. However, only 57.3% can get a requested antidote within two hours. Gastric lavage is the most widely used decontamination procedure, and the availability of extracorporeal decontamination techniques is between 67.2% and 79.6% (depending on type). Conclusion: Knowledge of specific antidotes correlated significantly with size, type, and region of hospital in China rather than with individual physician characteristics. Significant antidotes remain unavailable or unavailable within 2 h in about half of all hospitals surveyed, although all major acute decontamination treatments and techniques seem quite prevalent.

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Gastrointestinal decontamination in the acutely poisoned patient

Cited by 43 publications

References 151 publications

Availability of treatment resources for the management of acute toxic exposures and poisonings in emergency departments among various types of hospitals in Palestine: a cross-sectional study

Availability of treatment resources for the management of acute toxic exposures and poisonings in emergency departments among various types of hospitals in Palestine: a cross-sectional study

Pattern of acute poisoning in teaching hospital, northwest Ethiopia

The mastery of antidotes

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