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Medical expert of the article
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.
Complications of gastric lavage
With unqualified gastric lavage, a number of complications may develop, especially in patients with impaired consciousness, oppression of protective reflexes, and reduced muscular tone of the esophagus and stomach. The most dangerous of them are aspiration of the washing liquid, ruptures of the mucous membrane of the pharynx, esophagus and stomach, traumas of the tongue, complicated by bleeding and aspiration of the blood. The best way to prevent these complications, developing mainly in patients with gastric lavage at the prehospital stage by the linear ambulance teams is strict adherence to the correct procedure of this procedure. Before the introduction of the probe, it is necessary to hold the toilet of the oral cavity, with an increased pharyngeal reflex, the administration of atropine and lubrication of the pharynx with lidocaine is indicated, and in the unconscious state, a preliminary intubation of the trachea with a tube with an inflated cuff is necessary. It is inadmissible to introduce a rough probe to a patient who is resistant to this procedure, who is excited by the action of the toxicant or the surrounding environment. The probe should be pre-lubricated with petroleum jelly, its dimensions correspond to the patient's physical data. During this procedure, the average medical personnel need the participation or constant supervision of the doctor responsible for its safety.
Management of a patient after gastric lavage
After washing the stomach, it is recommended to inject various absorbent and laxatives into the interior to reduce absorption and accelerate the passage of the toxic substance through the digestive tract. The efficacy of using laxatives such as sodium or magnesium sulphate is very low, since they do not work fast enough (5-6 hours after administration) to prevent absorption of a significant part of the poison. In addition, when poisoning with drugs due to a significant decrease in intestinal motility, laxatives do not give the desired result. It is more effective to use as a laxative a vaseline oil (100-150 ml) that is not absorbed in the intestine and actively binds fat-soluble toxic substances, for example, dichloroethane.
Thus, the use of laxatives does not have independent significance as a method for accelerated detoxification of the body.
Along with laxatives in clinical practice, other methods of enhancing intestinal peristalsis are used. The detoxification effect of the cleansing enema is limited by the time it takes to pass a toxic substance from the small intestine to the thick one. Therefore, early application 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 a 4% solution of calcium chloride on a 40% glucose solution and 2 ml of 10 ED of pituitrin ® intramuscularly (contraindicated in pregnancy). The most pronounced effect is given by intravenous injection of serotonin.
However, all the 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.