Gastric lavage is especially important at the prehospital stage, as it leads to a decrease in the concentration of toxic substances in the blood.
The appearance of a vomiting reflex for certain types of acute poisoning should be considered as a protective reaction aimed at removing the toxic substance from the body. This process of natural detoxification can be intensified by vomiting or by mechanical irritation of the root of the tongue ("restaurant" method). The first method is practically not used in connection with the difficulties in controlling the intensity and duration of the emetic urge, as well as with various individual sensitivity to the drugs. The second is considered the main one for self- and mutual assistance in acute oral poisoning at the scene. However, there are situations when this method of emergency gastric cleansing is not recommended.
When poisoning with cauterizing liquids, spontaneous or artificially induced gag reflex is dangerous, as repeatedly passing acid or alkali through the esophagus can intensify its burn. There is another danger of an increase in the probability of aspiration of the cauterizing fluid and the development of a severe burn of the respiratory tract. In the state of toxic coma, the possibility of aspiration of gastric contents during vomiting is greatly enhanced.
These complications can be avoided using the probe method of gastric lavage. In comatose conditions, rinsing should be performed after intubation of the trachea, which completely prevents the aspiration of vomit. The danger of administering a probe for gastric lavage during poisoning with cauterizing fluids is greatly exaggerated, and the use of this method in the prehospital stage can reduce the prevalence of chemical burn and reduce the lethality in this pathology. It should be borne in mind that the use of a solution of sodium bicarbonate for acid poisoning is unacceptable, as it causes an acute expansion of the stomach formed by carbon dioxide and increases bleeding and pain.
In practice, in a number of cases, gastric lavage is discarded, referring to a long period of time that has elapsed since the poison was taken. However, when the autopsy is opened in the intestine, a significant amount of the toxicant is sometimes found even after 2-3 days after poisoning, which indicates that the refusal to wash the stomach is illegal. In case of severe poisoning with narcotic poisons and organophosphorus insecticides it is recommended to rinse the stomach every 4 to 6 hours. The need for this procedure is explained by the repeated intake of toxic substance into the stomach from the intestine as a result of reverse peristalsis and throwing into the stomach bile containing a number of unmetabolized substances (morphine, clozapine and other).
If, during poisoning with sleeping pills, intubation of the trachea at the pre-hospital stage is impossible for any reason, then gastric lavage should be postponed to a hospital in order to avoid complications, where both procedures are available.
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