Dr Ben Aston1, Dr Kate Allen1
1Lifeflight, Toowoomba, Australia
Abstract:
Objective: Paracetamol is commonly taken in overdose. Recent Australasian guidelines includes specific recommendations on transferring patients with paracetamol poisoning, which limit the need to transfer ingestions <30g where laboratory services are unavailable. We aim to investigate paracetamol overdose presentations attended by aeromedical retrieval services and the appropriateness of transfer.
Methods: This was a retrospective observational series of paracetamol overdose retrievals in Queensland, performed by LifeFlight Retrieval Medicine (LRM), Retrieval Services Queensland (RSQ), and the Royal Flying Doctors Service (RFDS) from January 2017-December 2021. Cases were identified through the respective services’ databases. Cases were excluded if retrieval case data were unavailable. Data extracted from case records included details of the ingestion, investigations, management, and the documented reason for patient transfer.
Results: There were 201 cases retrieved during the study period. Retrieval data were available for 151 cases that were included in the study. Paracetamol was taken in isolation in 52(34%) cases. The median dose ingested was 14.5g (IQR: 10g – 23.9g, range 2.5g – 109g). In 107(71%) cases, the antidote acetylcysteine was indicated to be commenced at the primary facility, however it was not commenced in seven (5%), it is unclear whether acetylcysteine was available in these instances.
Non-massive ingestions (≤30g) were taken in 89(59%) presentations. Of this group that potentially did not require retrieval according to current guidelines, the most common primary reason for retrieval was a lack of access to pathology services (50/89). Other primary reasons for transfer were requiring higher level of medical care (19/89), requiring management of co-ingestion (8/89) and requiring mental health review (5/89).
Conclusion: Current retrieval practice appears to transfer more patients than recommended in guidelines. Better aligning with the current Australasian guidelines may reduce the number of retrievals of patients with paracetamol overdose, providing sufficient acetylcysteine is stocked at rural centres.
Biographies:
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