Gastric decontamination

gastric decontamination

1. GASTRIC DECONTAMINATION Dr M.G.Reddy MD (P.G) Emergency

2. Gastric lavage is a method of gastrointestinal decontamination. Performed in the setting of an ingested overdose or acute poisoning, to decrease the absorption of substances in the stomach. This technique was first described in 1812. INTRODUCTION

3. Gastric lavage also commonly called stomach wash or gastric suction, is the process of cleaning out of the contents of the stomach. It has been used for eliminating poisons from the stomach. DEFINITION

4. For urgent removal of ingested substance to decrease systemic absorption. To empty the stomach before endoscopic procedure. To diagnose gastric hemorrhage and to arrest hemorrhage. PURPOSE

5. Gastric lavage is indicated to empty the stomach immediately, within 1 to 2 hours after an orally ingested overdose or poisoning and when not contraindicated should be considered where there is evidence or risk of significant INDICATION

6. Evident or high risk of morbidity or mortality:  Beta-blockers Calcium channel blockers Chloroquine  Cyanide Heavy metals antidepressants Paraquat OPC Phosphorus compound plant poison INDICATION WHEN INGESTED POISON

7. Poor absorption by activated charcoal Heavy metals Iron Lithium Toxic alcohols Con……

8. Ineffective or no antidotal therapy available Calcium channel blockers Colchicine Paraquat Selenious acid Con…..

9. Abnormal or absent pharyngeal/upper gastrointestinal anatomy Active or substantial antecedent vomiting Caustic ingestion Coagulopathy Decreased mental status Inactive or diminished airway reflexes CONTRAINDICATIONS

10. Large pills Large or sharp foreign body Nontoxic or minimally toxic ingestion Signifiant aspiration risk (e.g., hydrocarboné ingestion) Contraindications con…….

11. Equipments B owyer's tube B ite blocker L ignocaine gelly W ater basine N ormal water or Oil (generally coconut oil) PROCEDURE

12. Ryle’s tube Stethoscope Multi- para monitor Intubation tray oxygen Activated charcoal

13. Make yourself ready C ap Glass Mask Gown Gloves Shoes Technique

14. Prepare Patient 1.Explain the procedure to pt as well as relatives 2. Place the patient in the left lateral position and in 15 to 20 degrees of Trendelenburg

15. Measuring of tube length Use the largest diameter orogastric lavage tube. A size 32 to 36 Fr. Then measure length of tube from nose to ear lobe to xiphoid process and marked it.

16. Insertion of tube Apply the lignocaine gel on tube for lubrication

17. Insert the tube gently upto the marked and tell the pt to swallow it.

18. Confirm the tube position

19. Administer 100 - 300 ml(10 to 15ml/kg bwt ) of lavage fluid via the tube (in children, administer 50 - 100 ml). Then, manually agitate the stomach. After that, withdraw the fluid.

20. Repeat this until the lavage return is clear. Generally, anywhere from 5 to 20 L are required to thoroughly cleanse the stomach. Remember to save the aspirate for toxicology screening. After completion of the lavage , activated charcoal may be administered via the orogastric lavage tube. Technique con…..

21. Aluminium phosphide Zink phosphide Lavage with oil (generally with coconut oil) CONTRAIDICATION OF WATER WASH

22. Gastric lavage with Oil

23. Why coconut oil?

24. Paraquat poisoning Contraindication of oxygen

25. Decontamination Skin Remove contaminated clothing / wash skin completely with soap water followed by repeat body wash Q4th hrly Eyes Hair

26. Arm pits Groin Behind knees Between toes Pay special attention to Around ears Eyelids Inside nose Inside mouth Neck creases Decontamination ACT093©

27. Cardiac dysrhythmias Empyema Esophageal tear or perforation Gastric perforation Hypothermia Laryngospasm Complications

28. Nasal, oral, or pharyngeal injury Pneumothorax Pulmonary aspiration Pyriform sinus perforation Tracheal placement Tube impaction Complications con…

29. Do not use force to remove the lavage tube, as this may injure or rupture the stomach or esophagus

30. Activated charcoal

31. Charcoal (1g/kg) First line decontamination method MDAC- very useful First dose: 1 g / kg body weight Subsequent doses: 0.5 g / kg body weight at 6 th hourly up to 48 hours. Charcoal dose

32. C- Caustics, Corrosives H- Heavy metals A- Alcohol R- Rapid onset - cyanide C-Chlorine O- others ( Iron) A- aliphatic hydrocarbon L- lithium Doesn’t adsorb

33. Never with hold intubation if the patient in distress MDAC (RT and Rectal) decreases the need of antidotes and ICU stay If gastric lavage is delaying, charcoal is indicated don’t delay administer charcoal Continue lavage still clear water is returning Take home message

34. THANK YOU