What are common contraindications to activated charcoal under ICEMA standing orders?

• A. Altered mental status with risk of aspiration
• B. Ingestion of caustic substances
• C. Compromised airway
• D. All of the above

Answer: (D)

Activated charcoal should only be given when the patient can protect their airway and the substance is one that charcoal can adsorb. If the airway safety is in doubt or the substance ingested is caustic, charcoal is not appropriate.

Altered mental status with risk of aspiration means the patient may vomit and inhale material into the lungs, leading to dangerous airway injury or pneumonia; giving charcoal here adds the risk without a safe airway.

Ingestion of caustic substances is a contraindication because charcoal does not effectively adsorb caustics and can hinder evaluation or worsen mucosal injury, plus the aspiration risk remains.

A compromised airway makes administration unsafe because the patient cannot protect the airway, increasing the chance of aspiration and airway obstruction.

All of these conditions render activated charcoal inappropriate under ICEMA standing orders.