Guideline on the use of ipecac syrup in the out-of-hospital management of ingested poisons.
ABSTRACT The use of gastric emptying techniques, including ipecac-induced emesis, in the management of poisoned patients has declined significantly in recent years. Historically, poison centers used ipecac syrup in two ways. Ipecac syrup was administered to patients prior to referral to the emergency department in attempts to start the gastric emptying process as early as possible. Additionally, poison centers used ipecac syrup in attempts to keep patients from requiring referral to medical facilities. In these situations, ipecac syrup was administered in the home and poison center staff performed follow-up telephone calls to gauge progress and outcome. Studies to determine the effectiveness of ipecac syrup demonstrate that it induces vomiting in a high percentage of people to whom it is administered and that it decreases the gastrointestinal absorption of ingested substances in a time-dependent fashion. However, the effectiveness of ipecac syrup in affecting patient outcome has not been studied in adequate clinical trials. Its effectiveness in preventing drug absorption has only been documented for a limited number of substances and is substantially reduced if it is given more than 30-90 minutes following ingestion of the toxic material. There are potentially significant contraindications, adverse effects and related problems associated with the use of ipecac syrup. It is the consensus of the panel that the circumstances in which ipecac-induced emesis is the appropriate or desired method of gastric decontamination are rare. The panel concluded that the use of ipecac syrup might have an acceptable benefit-to-risk ratio in rare situations in which: there is no contraindication to the use of ipecac syrup; and there is substantial risk of serious toxicity to the victim; and there is no alternative therapy available or effective to decrease gastrointestinal absorption (e.g., activated charcoal); and there will be a delay of greater than 1 hour before the patient will arrive at an emergency medical facility and ipecac syrup can be administered within 30-90 minutes of the ingestion; and ipecac syrup administration will not adversely affect more definitive treatment that might be provided at a hospital. In such circumstances, the administration of ipecac syrup should occur only in response to a specific recommendation from a poison center, emergency department physician, or other qualified medical personnel. The panel decided not to address the issue of whether ipecac should remain a nonprescription, over-the-counter product. The panel does not support the routine stocking of ipecac in all households with young children but was unable to reach consensus on which households with young children might benefit from stocking ipecac. Instead, the panel concluded that individual practitioners and poison control centers are best able to determine the particular patient population, geographic and other variables that might influence the decision to recommend having ipecac on hand.
- SourceAvailable from: Emilio Carlos Elias Baracat[Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVE: Evaluate prospectively the frequency and cause of accidents in children seen at the Pediatric Emergency Service of a University Hospital. The main aim is to subsidize the development of education and preventive programs.METHODS: Data of all children, less than 14 years old, from March 1997 to February 1998 were collected with a standard questionnaire.RESULTS: Accidents in 3,214 children were studied, 11.4% of the total. Males predominated (62.1%). Accidents were more common in the 9 to 13 year age group (33.4%), 2 to 5 year age group (27.2%) and 5 to 9 year group (25,5%). Traumatism, mainly due to falls, was the cause in 74%. Head trauma was important in the younger than 1 year, and trauma involving the extremities in the 9 to 13 age group. Bites and stings predominated in the 5 to 13 year age group, intoxication and foreign bodies in the 2 to 5 years age group. Burns predominated in the younger than 5 years. Most accidents (89.7%) were of low complexity but 20 patients had to be admitted to an ICU and 4 died in the Emergency Room.CONCLUSIONS: The child older than 9 years, male, with trauma of the extremities due to a fall was the most frequent case of accident. Prevention programs must be targeted to specific age ranges. Accidents are responsible for a great part of the overload of Emergency Services as 89.7% were of low complexity. Primary care health facilities personnel must be trained to manage accidents that do not involve complex procedures.Jornal de pediatria 76(5):368-74. · 0.94 Impact Factor
- Jornal de Pediatria 01/2005; 81(5). DOI:10.1590/S0021-75572005000700012 · 0.94 Impact Factor
- American Journal of Emergency Medicine 10/2005; 23(5):589-666. DOI:10.1016/j.ajem.2005.05.001 · 1.15 Impact Factor