Paracetamol Overdose by IEDapps on iOS
Paracetamol Overdose is for assessing and managing paracetamol overdoses. It tells you how to assess risk, when to treat and gives you specific guidance based on your patient
Design and User Interface
It looks good and is very intuitive to use. The buttons and text are all clear and easy to press, no matter what size your fingers are. The graphics appear professional and well thought-out
Clinical Content
It has everything you could want when managing a paracetamol overdose:
- Options to go by blood results; quantity of drug ingested; or even total dose with a staggered overdose
- A guideline of how to assess whether a patient is ‘high risk’
- A plan for which investigations you need e.g. drugs levels, INR, LFTs
- Treatment plan which includes NAC doses and infusion rates
- An alert to tell you if the patient’s quantity of drug ingestion puts them close to a treatment line (within 10%)
Cost
- It’s free and with no ads
Room for Improvement
- The weight range starts at 30kg (11 year old child) so unfortunately doesn’t accommodate for younger kids/underweight teens.
- NAC treatment uses slightly different guidelines from current Australia/NZ protocol. The dose is the same but it recommends making it up in a higher volume of 5% dextrose.
- There is no way to view the actual nomogram, but this may be restricted for copyright reasons.
Overall
- Paracetamol overdose is a free, good-looking app that is easy to use. It gives clear guidance on assessment, investigations and treatment. It’s a must-have for anyone working in ED.
About Tessa Davis
Do you know which treatment line the app is using ? The UK have recently dropped their line below that of Aus / NZ.
(New UK guidelines )
Good question -- I’m not sure of the answer. However, I’ve contacted Haidar from IEDapps and asked him to reply here…
IEDapps have contacted me and have suggested that they could create a LITFL/Australian version for the Australian app store which would be very exciting indeed.
They have also pointed out that you can get the nomogram on the app (I just didn’t notice it).
Hopefully they will post on here soon and respond to the UK query -- I believe they are in the process of updating the app.
It is currently useless if you work in Australia or New Zealand as far as I can tell.
Chris
Depends where you work. Is pretty much the same as the one we were using in the last place I worked in Oz. But we are going to look at doing a LITFL Australian/NZ version that follows the latest guidelines.
No it is totally different -- the ANZ nomogram starts at 150 mg/L at 4h then halves every 4 hours (knowing that means you can actually draw it from scratch and look like an uber geek).
The old UK guidelines started at 200 for low risk, and at 100 for high risk.
C
Interesting. I can’t find my old hospital guidelines at the moment. But I can see the RCH http://www.rch.org.au/clinicalguide/guideline_index/Paracetamol_Poisoning/ Theirs starts at 100mg/L (same as high risk in the UK which is what we used).
One of the problems with pediatrics is that they are 20 years behind the rest of us in most things… RCH needs to update it guidelines, after all the national guidelines are only 4 years old: https://www.mja.com.au/journal/2008/188/5/guidelines-management-paracetamol-poisoning-australia-and-new-zealand-explanation
Chris
Hi I work with Haidar do not think the app recently updated. But would have used the previous UK Toxbase poisoning guidelines.
Thanks for posting -- yes, Haidar said it was based on old guidelines but he is updating it at the moment.
So before we kick off the app is a couple of years old now, and based entirely on the UK toxbase guidelines as they were until September this year.
Looking back to when we designed it, I remember that we were mostly concerned about getting the complicated A3 posters we are used to and shrinking it down to as few touches as possible (5), you have everything you need on one results page, including prescription etc..
As you correctly note, in the UK we have dropped the low risk line. So in essence we don’t have high or low risk patients any more, only patients, all of who are deemed to live on the high risk line.
Also the advice regarding the reconstitution of NAC has changed slightly.
We are updating the app to reflect this, but if you guys want a LITFL version that better reflects what you do then we are all ears, it’s no biggie for us, since we are doing the work anyway.