Aspiration pneumonia following severe self-poisoning

Accuracy of Admission Glasgow Coma Scale to Predict Aspiration Pneumonia in Poisoned Patients

“…Some authors claim not to intubate patients with decreased GCS but particular poisoning and preserved airway protection [4]. In a series of severe self-poisoning, comatose patients brought non-intubated to the emergency department had a 3 fold increased risk of aspiration [5]. The rate of aspiration was doubled if the patient was unconscious but intubated on the scene or received activated charcoal in this series.…”

“…Additional increased risk by inappropriate management is often outlined by authors [5]. Prevention of gastrointestinal absorption by either gastric lavage or administration of activated charcoal can be effective if appropriate.…”

Vidange gastrique et prévention de l’absorption des toxiques aux urgences

“…L'enjeu pour le praticien urgentiste est donc d'identifier rapidement les patients les plus à risque et qui pourraient utilement bénéficier d'une épuration digestive et notamment du lavage gastrique. En effet, cette technique n'est pas dépourvue d'effets secondaires graves, faisant pencher la balance bénéfice/risque du côté négatif [4] : hypoxie, pneumopathie d'inhalation [5,6], troubles du rythme, laryngospasme, perforation oesophagienne [7] ou pharyngée. Le lavage gastrique implique le passage d'un tube de diamètre conséquent (tube de Faucher taille 33 par exemple) par voie orale jusque dans l'estomac.…”

Activated charcoal for pediatric poisonings: the universal antidote?

“…It has been pointed out, however, that the study was underpowered and that MDAC was indicated in only 7% of the patients [18]. In a retrospective study, Liisanantti et al [35] concluded that in unconscious patients (Glasgow Come Score (GCS) < 8), those at highest risk for aspiration were those with the longest time without intubation and those given charcoal without securing the airway. From their data, it did not appear that there was a significant difference in risk of aspiration between unconscious patients not immediately intubated in the field and unconscious unintubated patients receiving charcoal in the hospital setting.…”

“…There was also no difference in risk for aspiration between an unconscious patient who was immediately intubated in the field compared with an unconscious intubated patient given charcoal. They concluded that to decrease the risk of aspiration pneumonitis in a poisoned patient with a GCS less than 8, intubation in the field is recommended [35].…”