Activated Charcoal

Common Errors

Critical errors in prehospital application of activated charcoal:

• Failing to reassess after intervention. Vital signs must be rechecked every 5 minutes for unstable patients
• Incorrect medication dosing. Always use length-based estimation (Broselow tape) for pediatric patients
• Tunnel vision on one finding while missing the complete clinical picture
• Not communicating changes to receiving facility during transport

Clinical Significance

In prehospital care, understanding activated charcoal can mean the difference between a positive patient outcome and a critical miss. An elderly woman found on the floor after a fall. Alert but confused, hip pain with external rotation and shortening of right leg. Suspect hip fracture: splint in position found, monitor for shock.

Related pharmacology: midazolam at 2-5mg IV/IM, 0.2mg/kg IN, indicated for Seizures, sedation.

Equipment & Tools

Equipment used in activated charcoal assessment and treatment:

Pulse oximeter

Measures SpO2 via infrared absorption through capillary bed. Available sizes: Finger clip, Earlobe, Pediatric wrap

AED

Automated external defibrillator for VF/pVT. Available sizes: Adult pads (over 8yo or 25kg), Pediatric pads (under 8yo or 25kg)

IO drill

Intraosseous access device for emergent vascular access. Available sizes: EZ-IO: 15mm (peds), 25mm (adult), 45mm (obese)

Step-by-Step Procedure

Protocol steps for activated charcoal:

RSI sequence: preoxygenation then sedation (etomidate 0.3mg/kg or ketamine 2mg/kg) then paralytic (succinylcholine 1.5mg/kg or rocuronium 1mg/kg) then intubation then confirm placement with waveform capnography

Regulatory Context

Regulatory context for activated charcoal includes federal and state requirements. Healthcare facilities must comply with CMS Conditions of Participation, state licensure requirements, and accreditation standards (Joint Commission or AAAHC). Non-compliance can result in citations, fines, or loss of Medicare/Medicaid reimbursement.