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국내 응급의료센터의 중독 환자에 있어 활성탄 투여 현황과 응급실 의료진의 인식

Survey of Activated Charcoal Administration for Poisoning Patients Visited in Emergency Medical Centers and Emergency Staff's Perception in Korea

  • 배성진 (이화여자대학교 의과대학 응급의학교실) ;
  • 최윤희 (이화여자대학교 의과대학 응급의학교실) ;
  • 이덕희 (이화여자대학교 의과대학 응급의학교실)
  • Bae, Sung Jin (Department of Emergency Medicine, Ewha Womans University) ;
  • Choi, Yoon Hee (Department of Emergency Medicine, Ewha Womans University) ;
  • Lee, Duk Hee (Department of Emergency Medicine, Ewha Womans University)
  • 투고 : 2016.12.26
  • 심사 : 2017.03.24
  • 발행 : 2017.06.30

초록

Purpose: Activated charcoal (AC) has been widely used as a universal antidote. Currently, emergency medical centers in Korea cannot administer AC due to discontinuation of the supply of commercial ready-mixed AC suspension. This study was conducted to investigate the proportion of emergency medical centers that administer AC to poisoning patients and provide basic information for emergency physicians and toxicologists. Methods: A prospective telephone survey of all of the included emergency medical institutions was conducted. The type of emergency medical institution, average annual number of patients admitted to the emergency department, annual average number of patients who were poisoned and whether the hospital currently utilizes gastric lavage and administration of AC were determined. Results: AC was administered to poisoning patients in 40% of regional emergency medical centers, 59.3% of local emergency medical centers, and 45.9% of local emergency medical rooms. Overall, 37% of total emergency medical institutions did not administer AC due to discontinuation of the commercial ready-mixed AC suspension. Additionally, 77% of emergency physicians in institutions without AC knew AC is necessary for poisoning patients. The rate of vomiting experienced by the medical staff according to types of charcoal showed that the average rate of vomiting was 33% for commercial ready-mixed activated charcoal suspension and 51% for self-prepared charcoal powder (p=0.02). Conclusion: AC should be secured promptly in emergency medical institutions. Before the supply of commercial ready-mixed AC suspension becomes again it is essential to develop a standardized regimen for self-preparation of charcoal powder and to educate emergency physicians and toxicologists to its use.

키워드

참고문헌

  1. Division of Chronic Disease Control, Center for Disease Prevention Korea centers for disease control and prevention. Emergency department based injury in-depth surveillance. 2006-2015 Statistics of injury type and Cause. 2016. p.14-5.
  2. Kim KW, Yoon SK, Jung YS, Choi SC. Clinical toxicology. Koonja; 2006. p54-60.
  3. Ghim BK, Choi SY, Kang IJ, Kang YJ, Kwon BS, Lee JE, et al. Association between nasogastric tube insertion and aspiration pneumonia in drug intoxication. Korean J Med 2010;78:87-94.
  4. Juurlink DN. Activated charcoal for acute overdose: a reappraisal. Br J Clin Pharmacol 2016;81(3):482-7. https://doi.org/10.1111/bcp.12793
  5. Olson KR. Activated charcoal for acute poisoning: one toxicologist's journey. J Med Toxicol 2010;6:190-8. https://doi.org/10.1007/s13181-010-0046-1
  6. Chung SP, Hwang TS, Kim SH, Choi YH, Chang WJ, Oho JH. Comparison on the adsorptive capacity of Fuller's earth, Actidose $Aqua^{(R)}$ and activated charcoal. J Korean Soc Emerg Med 2000;11(1):137-43.
  7. Corcoran G, Chan B, Chiew A. Use and knowledge of single dose activated charcoal: A survey of Australian doctors. Emerg Med Australas 2016;28(5):578-85. https://doi.org/10.1111/1742-6723.12659
  8. Friberg LE, Isbister GK, Duffull SB. Pharmacokineticpharmacodynamic modelling of QT interval prolongation following citalopram overdoses. Br J Clin Pharmacol 2006;61(2):177-90. https://doi.org/10.1111/j.1365-2125.2005.02546.x
  9. Chang KS, Hwang SC, Lee DY, Sands CD, Clemmons RL, Jones DW et al. Effect of multiple dose oral activated charcoal on theophylline pharmacokinetics. Tuberc Respir Dis 1987;34(2):162-7.
  10. Chung SP, Hwang TS, Choi SW, Kim SH, Lee SH. Acute dapsone intoxication. J Korean Soc Emerg Med 1997;8(2): 147-52.
  11. You JS, Chung SP, Kim EC, Lee HS, Kim SH. Survey of the antidote stocking in the emergency medical centers in Korea. J Korean Soc Clin Toxicol 2007;5(2):106-11.
  12. Chyka PA, Seger D. Position statement: single-dose activated charcoal. American Academy of Clinical Toxicology; european Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol 1997;35:721-41. https://doi.org/10.3109/15563659709162569
  13. Chyka PA, Seger D, Krenzelok EP, Vale JA. Position paper: Single-dose activated charcoal. Clin Toxicol 2005; 43(2):61-87. https://doi.org/10.1081/CLT-51867
  14. Kim SH, Kang NR, Sohn I, Lee H, Lee YK, Song SH. Acute respiratory distress syndrome with chemical pneumonitis after aspiration of activated charcoal. Korean J Crit Care Med 2010;25(2):112-7. https://doi.org/10.4266/kjccm.2010.25.2.112
  15. Chyka PA, Seger D, Krenzelok EP, Vale JA. Position paper: Single-dose activated charcoal. Clin Toxicol 2005; 43:61-87. https://doi.org/10.1081/CLT-51867
  16. Greene SL, Kerins M, O'Connor N. Prehospital activated charcoal: the way forward. Emerg Med J 2005;22(10): 734-7. https://doi.org/10.1136/emj.2005.024968