Paeds SAQs · acute-care-resuscitation-and-toxicology
Poisoned child: structured assessment and decontamination — formative SAQs
Two MedVellum formative short-answer questions on the poisoned child: resuscitation before decontamination, taking the four-question ingestion history and reading the toxidrome, calling the Poisons Information Centre early, and deciding on activated charcoal within the first hour only when the airway is safe and the toxin is adsorbable. SAQ 2 covers the decontamination decision ladder, whole bowel irrigation for iron and sustained-release ingestions, and safeguarding in parallel. The marks and timing support transparent self-assessment. They are not an official board format or pass standard.
On this page
Study tools
Target exams
SAQ 1 — A toddler with an open bottle of adult medication
Question 1 — 10 formative marks; suggested time 15 minutes [9]
A two-year-old is brought in forty minutes after her parent found her with an open bottle of the grandparent's medication. The bottle is labelled but the number of missing tablets is uncertain. The child is alert, pink, with normal observations. The team has been called. [9]
- State what you do in the first 60 seconds and why. (2 marks)
- Take the structured ingestion history: name the four questions and what each must establish. (2 marks)
- State the principle for activated charcoal in this child, including the dose, the timing window and the conditions that must be met. (3 marks)
- State three circumstances in which you would NOT give activated charcoal, and why. (3 marks) [9]
Full-credit answer — SAQ 1
Reveal full-credit answer for SAQ 1ShowHide
1. First 60 seconds
"This child is currently stable but the exposure is uncertain and the time is within the intervention window. I call the senior paediatric team, confirm the primary survey is normal (airway, breathing, circulation, glucose), obtain a working weight, and keep the child on continuous monitoring. I ask the parent to bring the container and any remaining tablets, and I take the structured ingestion history. Stabilisation and observation run while the toxin is identified." [9]
2. The four questions
"I ask: what was taken, reading the exact product from the container or a photograph of the label; how much, estimating the maximum number of missing tablets or volume from what was originally present; when, the time of ingestion, which sets the charcoal window; and what else, asking about co-ingestants, other medications in the home and recreational substances. I add the route, the child's weight, and any relevant past history." [9]
3. Activated charcoal principle
"Activated charcoal is given at 1 g/kg body weight to a maximum of 50 g as a single dose, ideally within the first hour of ingestion. It is given only when the airway is protected, the child is not vomiting, the toxin is adsorbable by charcoal, and the exposure is significant enough to justify intervention. I confirm the toxin is adsorbable against the Poisons Information Centre advice before giving it." [3] [12]
4. When NOT to give charcoal
"I do not give activated charcoal when the airway is unprotected or the child has a reduced conscious level without a plan to secure the airway, because aspiration pneumonitis can be severe. I do not give it after corrosive or hydrocarbon ingestion, because it worsens tissue injury and aspiration risk without benefit. And I do not give it for iron, lithium, metals, toxic alcohols or cyanide, because these substances are not adsorbed by charcoal." [3] [5]
References6ShowHide
- [1]Hoffman RJ, Nillas A Toxidromes and a general approach to poisoning Archives of disease in childhood, 2025.PMID 39978865
- [3]Hoegberg LCG, Shepherd G, Wood DM, et al. Systematic review on the use of activated charcoal for gastrointestinal decontamination following acute oral overdose Clinical toxicology (Philadelphia, Pa.), 2021.PMID 34424785
- [5]Zhao X, Dughly O, Simpson J Decontamination of the pediatric patient Current opinion in pediatrics, 2016.PMID 27031659
- [7]Tenenbein M Position statement: whole bowel irrigation. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists Journal of toxicology. Clinical toxicology, 1997.PMID 9482429
- [9]Berg SE, McCann SD Pediatric Toxicology: An Updated Review Pediatric annals, 2023.PMID 37036778
- [12]Bond GR The role of activated charcoal and gastric emptying in gastrointestinal decontamination: a state-of-the-art review Annals of emergency medicine, 2002.PMID 11867980