Availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in emergency departments in Malaysia

Abstract

Acute poisoning is a common medical emergency in Malaysia. Life can be saved if the patient is diagnosed properly and receives the appropriate treatment such as gastrointestinal decontamination techniques and resources to increase poison elimination according to clinical guidelines at a reasonable time. The aims of this study were to determine the availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in accident and emergency departments in Malaysia, and to compare the availability of such facilities among various types of hospitals. A comparative, descriptive cross-sectional study was conducted using a structured questionnaire. Seventy-four (58.3%) out of the targeted 127 hospitals replied and completed the questionnaire. The availabilities of most items related to stabilization resources were far better in general hospitals compared to district hospitals with specialists and district hospitals without specialists. These items were mechanical ventilators (p = 0.011), non-invasive positive pressure ventilators (0.024), pacemakers (p = 0.019), and transcutaneous cardiac pacing (p < 0.001). The availability of decontamination resources varied substantially with hospital type. Nevertheless, these differences did not reach statistical significance in any of the cases, whereas sodium sulphate, sorbitol, and polyethylene glycol were almost never available. The availabilities of most items related to elimination enhancement resources were far better in general hospitals and district hospitals with specialists compared to district hospitals without specialists. These items were haemodialysis (p = 0.046), haemoperfusion (p = 0.002), haemofiltration (p = 0.002), acid diuresis (p = 0.04), peritoneal dialysis (p < 0.001), and exchange transfusion (p < 0.001). Most Malaysian hospitals have certain important immediate interventions such as gastrointestinal decontamination techniques and resources to increase poison elimination. The availabilities of most facilities were far better in the general hospitals. Coordination between the National Poison Centre in Malaysia and hospitals should be established regarding the emergency facilities for effective management of poisoning cases in each hospital in order to direct the poisoned patients to the hospital where the appropriate management resources is available.

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

“…The results of our study concerning the availability of GI decontamination resources are consistent with the Malaysian study performed by Awang et al [8], except for AC dosage form. The authors, through the survey that they conducted, reported that the availability of charcoal tablets was better than powdered form, and that they were available in more than two-thirds of the EDs.…”

“…Currently, there are no generally recognised specific criteria that define the preparedness of an ED for the management of acute toxic exposures and poisonings. A list of commonly required resources and items which might be used for the treatment of acute poisoning was compiled from the published recommendations [8,11,16,27-31]. …”

“…The second section was designed to indicate which resources were available in their EDs, such as equipment for decontamination, life support, and elimination enhancement instruments. A list of commonly required resources used for the treatment of acute poisoning was compiled from the published recommendations [8,27,28]. …”

“…An example of this is the treatment of patients diagnosed with paracetamol poisoning with N-acetylcysteine within 8 hours [7]. In addition, the treatment of poisoning cases in the ED begins with stabilising the patient and assessing the vital signs, starting with ABC (airway, breathing and circulation), which is sometimes followed by gastrointestinal (GI) decontamination or the immediate use of an antidote [6,8]. Supportive measures include the use of commonly stocked medicines such as adrenaline and sodium bicarbonate [9].…”

The mastery of antidotes

“…7 The treatment of poisoning cases in the ED begins with stabilizing the patient and assessing vital signs, starting with the ABCs (airway, breathing, and circulation), followed by gastrointestinal (GI) decontamination as indicated, and/or the immediate use of a possible antidote. 8 One key issue in this chain of events, however, is how much does the physician working in ED know about antidotes? And how many resources are available to the physician for assistance as needed?…”