Wednesday, March 9, 2011

Patient safety and therapeutic charcoal

Last night I worked triage for the second night in a row (FML) and naturally because it's me and my life it was stupid busy and everyone had some kind of complicated complaint and I didn't pee until the wee hours of the morning, etc. Beds are just not happening, half of our ER are holds so actual sick people are waiting for hours on end when some teenage girl comes in with her mom for dizziness.
Mom actually seems like a normal person but clearly shook her daughter either too much or not enough when she was younger because she is acting completely foolish. The story is that the daughter took some unidentified meds that a friend left at her house because she had a headache- great plan, I know I always take someone else's random meds when I have a headache that I don't know the purpose of instead of just taking a damn tylenol. Anyway, they bring me the pill so I type it into the database and see that it's a prednisone tab. Well, it may make you nauseated but two certainly won't kill you. To the waiting room you go. So then, out of nowhere, this fool suddenly remembers some other pill that she took that is of course very generic in it's description that she naturally did not bring with her.
Mom is clearly about to slap her, as all this fuckery supposedly went down while she was at work. She asks her if she took anything else, to which she of course replies " I can't remember". May I also just say that 16 year olds really suck at lying. Really. Despite all that, I'm in a bind where I have to call the charge nurse and just let her know. She is a friend and very similar minded in what bullshit all this is, but we are put in a very bad place if any drama goes down if we admit to sending what's technically a pediatric patient who ingested an unknown med in unknown amounts back out to the waiting room because she sounded like she was lying. So homegirl then gets to skip over all the chest pains and such that have been waiting 4 hours patiently, and take our last available room.
Now. I know it's not in my scope of practice to order meds, but I truly believe that this situation calls for some charcoal with sorbitol, stat. I mean, she didn't know what pills she took or how many! Patient safety! Instead she got Ativan and Maalox. Um, no sir. You're fired or at least suspended until you are re-educated on the hood hospital therapeutic charcoal policy. It's in your manual between right after therapeutic NG tubes and O neg transfusion worthy IV sites for people who might be vomiting blood. Safety first, people.


  1. Sounds like she attended a skittles party. Kids raid their parents/grandparents' medications and toss everything they find into a bowl and just take handfuls. Some kid around here died a couple of years back from Imdur and Viagra.

  2. Really? This makes me feel so old. I was in high school less than ten years ago, but I swear I was not THAT dumb. I can't even imagine how stupid my children's peers will be.

  3. There is really very little evidence for charcoal in toxicology. Perhaps for drugs with entero-hepatic recirculation, but for little else. I cannot think of any single pill ingestion I would use charcoal for. Charcoal aspiration is an absolute nightmare.
    I understand the use of punitive charcoal, but I don't think it is worth the risk...My 2 cents,
    Dr. J

  4. Skittles? Is that the new rainbow party? Ten years ago, they were content with wearing different color lipstick and giving all the guys BJs.

  5. A former boss of mine, a full-grown, successful adult man, ended up missing several days of work because he randomly took some Parkinson's meds instead of Tylenol.

  6. dr J said there was very little tberapeutic use to administering sorbitol for drug overdoses. I disagree. If the taste and texture changes the mind of even 1 teenage girl about trying to take her life through OTC meds, then its worth it.

  7. The practice of kids dumping a bunch of meds in a big bowl and randomly taking a handful is also called "pharming." The idiocy of that is beyond belief but it really happens. It's scary how stupid kids can be!

    And don't you think she probably should have had a foley, too, in case the "mystery" med was toxic to her kidneys? Cervical collar in case she fell and didn't remember?