The knowledge and practice of emergency department doctors in the management of calcium channel blocker overdose in South Africa

Abstract

Background: Calcium channel blocker (CCB) overdose (OD) has the highest mortality rate in comparison to other cardiovascular agents. The treatment of a severe CCB OD is challenging for emergency doctors with limited literature even in developed countries. It is important that in the South African (SA) setting that good knowledge and awareness of emergency doctors on CCB OD’s and their clinical presentations, would produce fewer patient mortalities. Objectives: To explore the knowledge and practice of SA emergency department (ED) doctors, in both public and private sectors, in the management of CCB OD as well as barriers and facilitating factors they encounter when managing such patients. Methods: A cross-sectional study was conducted among South African emergency medicine doctors using a self-administered electronic survey. The survey contained 39 questions including demographics and a combination of open, closed, case-based and Likert-scale based multiple-choice questions as adapted from Brassard et al. Results: A total of 119 doctors participated in the survey, 59 were state medical officers (MO), 30 were registrars and 30 worked in private EDs. The mean (SD) age of participants was 32.9 years (6.4). The mean knowledge (SD) score of all participants was 54% (13.3), which was the lowest for public MOs (48%) and significantly higher for private MOs (58.4%) and registrars (60.1%). Forty eight percent of participants didn’t know of any guidelines to treat a CCB OD. Current practice of EM doctors showed that fifty-five percent of the group would initiate HIET along with a vasopressor for CCB induced shock. Barriers to managing a CCB OD were highlighted with unavailability of infusion pumps, understaffing in the unit, and a full resuscitation unit being the most common with no significant differences between the subgroups. Thirty seven percent of participants agreed that the most popular facilitating factor was having past experience when managing a CCB OD. Conclusion: This study has highlighted the need to address ED doctor knowledge gaps on CCB OD management, further emphasising the importance of clinical toxicology education in South Africa. Guidelines are needed to improve EM doctor practices to ameliorate patient outcomes.