Gastric lavage

Gastric lavage is especially important at the pre-hospital stage, as it leads to a decrease in the concentration of toxic substances in the blood.

The occurrence of a gag reflex in some types of acute poisoning should be considered a protective reaction aimed at removing a toxic substance from the body. This process of natural detoxification can be enhanced by emetics or mechanical irritation of the root of the tongue (the "restaurant" method). The first method is practically not used due to the difficulties of controlling the intensity and duration of the gag reflex, as well as different individual sensitivity to drugs. The second is considered the main one for self- and mutual assistance in acute oral poisoning at the scene of the incident. However, there are situations when this method of emergency gastric cleansing is not recommended.

In cases of poisoning with caustic liquids, a spontaneous or artificially induced gag reflex is dangerous, since repeated passage of acid or alkali through the esophagus can intensify its burn. There is another danger - an increased likelihood of aspiration of caustic liquid and the development of a severe burn of the respiratory tract. In a state of toxic coma, the possibility of aspiration of gastric contents during vomiting increases significantly.

These complications can be avoided by using a gastric lavage tube. In comatose states, lavage should be performed after tracheal intubation, which completely prevents aspiration of vomit. The danger of introducing a gastric lavage tube in cases of poisoning with caustic liquids is significantly exaggerated, while the use of this method at the pre-hospital stage can reduce the prevalence of chemical burns and reduce mortality in this pathology. It should be taken into account that the use of sodium bicarbonate solution in cases of acid poisoning is unacceptable, since it causes acute gastric dilation with the resulting carbon dioxide and increases bleeding and pain.

In practice, in a number of cases, gastric lavage is refused, citing the long period of time that has passed since the poison was taken. However, during autopsy, a significant amount of toxicant is sometimes found in the intestines even 2-3 days after the poisoning, which indicates that refusing gastric lavage is unlawful. In severe poisoning with narcotic poisons and organophosphorus insecticides, repeated gastric lavage is recommended every 4-6 hours. The need for this procedure is explained by the repeated entry of the toxic substance into the stomach from the intestine as a result of reverse peristalsis and the reflux of bile into the stomach, containing a number of unmetabolized substances (morphine, clozapine, etc.).

If, in cases of poisoning with sleeping pills, tracheal intubation at the pre-hospital stage is impossible for some reason, then, in order to avoid complications, gastric lavage should be postponed until a hospital where both procedures can be performed.

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Complications of gastric lavage

If gastric lavage is performed unskilled, a number of complications may develop, especially in patients with impaired consciousness, suppression of protective reflexes and reduced muscle tone of the esophagus and stomach. The most dangerous of these are aspiration of the lavage fluid, ruptures of the mucous membrane of the pharynx, esophagus and stomach, tongue injuries complicated by bleeding and aspiration of blood. The best way to prevent these complications, which develop mainly in patients who underwent gastric lavage at the pre-hospital stage by linear ambulance teams, is strict adherence to the correct technique of this procedure. Before inserting the tube, it is necessary to clean the oral cavity; with an increased pharyngeal reflex, it is indicated to administer atropine and lubricate the pharynx with lidocaine, and in an unconscious state, preliminary tracheal intubation with a tube with an inflatable cuff is necessary. Rough insertion of the tube into a patient who resists this procedure, who is excited by the action of a toxicant or the surrounding environment is unacceptable. The probe must be pre-lubricated with Vaseline oil, and its dimensions must correspond to the patient's physical characteristics. During the procedure, the mid-level medical personnel must be present or constantly monitored by a physician responsible for its safety.

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Management of the patient after gastric lavage

After gastric lavage, it is recommended to administer various adsorbents and laxatives to reduce absorption and speed up the passage of the toxic substance through the gastrointestinal tract. The effectiveness of using laxatives such as sodium or magnesium sulfate is very low, since they do not act quickly enough (5-6 hours after administration) to prevent the absorption of a significant portion of the poison. In addition, in cases of poisoning with narcotic drugs, due to a significant decrease in intestinal motility, laxatives do not give the desired result. A more effective laxative is the use of vaseline oil (100-150 ml), which is not absorbed in the intestine and actively binds fat-soluble toxic substances, such as dichloroethane.

Thus, the use of laxatives has no independent value as a method of accelerated detoxification of the body.

Along with laxatives, other methods of enhancing intestinal peristalsis are also used in clinical practice. The detoxifying effect of a cleansing enema is limited by the time required for the passage of the toxic substance from the small intestine to the large intestine. Therefore, early use of this method in the first hours after poisoning is ineffective. To reduce this time, it is recommended to use pharmacological stimulation of the intestine by intravenous administration of 10-15 ml of 4% calcium chloride solution in 40% glucose solution and 2 ml of 10 U of pituitrin® intramuscularly (contraindicated in pregnancy). The most pronounced effect is achieved by intravenous administration of serotonin.

However, all means that stimulate the motor-evacuation function of the intestine are often ineffective due to the toxic blockade of its neuromuscular apparatus in severe poisoning with narcotic drugs, organophosphorus compounds and some other poisons.