Risk Management Pitfalls:
1. “I wanted to do SOMETHING for this child. His parents brought him all the way here and were very worried.” Perhaps the hardest thing to do for children who present after an ingestion is nothing. When a child presents more than 1 hour after ingestion, there is no conclusive evidence for decontamination of any method.
2. “He was too sleepy to drink the activated charcoal, so we gave it via NG tube.” Children with depressed mental status are at high risk of aspiration and should have an airway secured prior to any method of decontamination. It is essential to thoroughly assess the patient’s mental status, including his or her ability to protect the airway, before treatment.
3. “If a patient presents with an overdose, I pump the stomach! Isn’t that standard of care?” Gastric lavage, or ‘pumping the stomach,’ is not standard of care for adults or children who have ingested a toxin. The available evidence shows that it adds no benefit to SDAC in poisoned patients. In addition, it carries a significant risk of aspiration.
Purchase the individual issue for more risk management pitfalls.
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