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Activated Charcoal

Category: Pharmacology Sources: raw/supplemental/emt-b-pharmacology.md Last updated: 2026-04-03

Overview

Activated charcoal is an adsorbent used for certain ingested poisonings, given within one hour of ingestion before significant gastric absorption occurs. It works by binding the toxin in the GI tract, preventing systemic absorption. Use is declining in many EMS systems due to aspiration risk and limited efficacy evidence in the field — always check current NM protocol before administration.

Key Points

  • Indications:
  • Certain ingested poisons or drug overdoses
  • Patient is conscious and able to protect airway
  • Ingestion occurred within approximately 1 hour
  • Dose:
  • Adult: 25–50 g (1 g/kg body weight)
  • Pediatric: 12.5–25 g (1 g/kg)
  • Mixed with water; patient must drink it (has a gritty, unpleasant texture — patient cooperation is critical)
  • Contraindications:
  • Altered mental status (aspiration risk)
  • Unable to swallow
  • Caustic ingestions (acids, alkalis — charcoal does not bind them; may worsen injury)
  • Petroleum product ingestions (hydrocarbons, gasoline)
  • Suspected GI perforation
  • Authorization: Standing order or online medical direction required. Many systems have removed activated charcoal from BLS formulary — verify current protocol.
  • Reassess: Monitor airway closely; watch for vomiting and aspiration risk.

Assessment Relevance

Activated charcoal consideration arises in the toxicological patient — found during history-taking (SAMPLE: events leading to incident, medications, past history). Scene clues: - Pill bottles (type and count helps estimate dose) - The patient or bystanders report ingestion - Patient found near substances

Critical assessment questions before administration: - What substance was ingested? (Is it one charcoal actually binds?) - When was it ingested? (Within 1 hour?) - Is the patient awake and alert enough to drink and protect their airway?

Many ingestions that arrive in EMS are either too late for charcoal to be effective (>1 hour), involve substances charcoal does not bind (caustics, alcohols, heavy metals, hydrocarbons), or involve patients too altered to safely receive it. The contraindication list is more commonly met than the indication list.

Procedures

  1. Identify ingestion via history-taking — substance, time, amount.
  2. Screen for contraindications (altered LOC, caustic, hydrocarbon, inability to swallow).
  3. Confirm ingestion was within approximately 1 hour.
  4. Obtain authorization (standing order or medical direction).
  5. Mix activated charcoal with water (premixed preparations commonly available).
  6. Have patient drink through a straw or cup — monitor closely.
  7. If patient vomits, manage airway immediately; do not attempt to re-administer.
  8. Monitor airway continuously after administration.
  9. Document: substance ingested, time of ingestion, dose of charcoal given, route, authorization, patient response.

NM Protocol Notes

  • Activated charcoal status in NM EMS is protocol-specific — it is falling out of favor. Verify with current NM EMS Bureau protocol for San Juan region whether it remains in EMT-B formulary.
  • Poison Control Center (1-800-222-1222) can provide substance-specific guidance on whether activated charcoal is appropriate for a given ingestion — contact early on suspected poisoning calls.
  • Many NM systems now defer charcoal to the ED rather than administering in the field.

NREMT Relevance

Activated charcoal is tested on the NREMT cognitive exam. Common question angles: - Recognizing a contraindication: "The patient is drowsy and slurring words — would you give activated charcoal?" → No, altered mental status is a contraindication (aspiration risk) - Substance contraindications: caustics and petroleum products — charcoal does not bind them - Time window: approximately 1 hour after ingestion - Administration: mixed with water, patient drinks it - Dose: 1 g/kg (know adult and pediatric ranges: 25–50g and 12.5–25g)

The NREMT will test your ability to recognize when NOT to give activated charcoal more than when to give it — the contraindication list is the high-yield material.

  • history-taking — SAMPLE history (events, medications) drives identification of ingestion
  • primary-assessment — LOC and airway assessment determine whether patient can safely receive charcoal
  • reassessment — monitor airway closely after administration; watch for vomiting

Sources

  • raw/supplemental/emt-b-pharmacology.md — Activated Charcoal section and General Medication Administration Rules