Analysis of clinical characteristics of 294 acute poisoning patients with gastric lavage / 中华急诊医学杂志

Objective:To describe the current situation of gastric lavage operation and put forward measures for improvement by analyzing the clinical characteristics of 294 patients with gastric lavage in Poisoning Treatment Center of The First Affiliated Hospital of Nanjing Medical University.Methods:The clinical data of 294 patients with acute poisoning and gastric lavage from 2019 to 2021 were collected and analyzed retrospectively, and the related parameters (poison type, gastric lavage volume, poisoning to gastric lavage time, etc.) of each year were compared.Results:A total of 653 poisoning patients underwent gastric lavage from 2019 to 2021, with an average age of (44.2 ±20.1) years, and 134 (45.6%) were male. The main causes of gastric lavage were pesticide poisoning (52.72%) and drug poisoning (42.86%). The volume of gastric lavage was less than 10 L for 43.8% of patients and 10-20 L for 32.7% of patients. Patients with gastric lavage within 60 min after ingestion of poison accounted for 45.3%, followed by 25.8% within 61-120 min. The in-hospital mortality rate was 17.7%. The common complications of gastric lavage were: the incidence of gastrointestinal bleeding (55/121, 45.5%), the incidence of aspiration pneumonia (54/140, 38.6%), and the incidences of electrolyte disorder (21% of low potassium, 29% low calcium, and 10.0% low sodium). Compared with the groups in different years, the proportion of gastric lavage in poisoning was 58.85% vs. 46.60% vs. 32.41%, which decreased year by year, with statistical difference ( P <0.05). And there was no difference in the period from ingestion to gastric lavage and gastric lavage fluid volume. There was an increasing trend in poison types between diquat and other insecticides, but there was no statistical difference. Conclusions:From 2019 to 2021, the most common causes of acute gastric lavage were pesticide poisoning and drug poisoning, and the proportion of diquat and other pesticides showed an overall upward trend. A majority of the patients (71.1%) had gastric lavage within 2 h, and 76.5% of the patients had less than 20 L gastric lavage fluid. In the future, we will further control the amount of gastric lavage fluid and pay attention to the gastric lavage operation of new insecticide poisoning.

A death case of oral lime sulfur mixture poisoning / 中华劳动卫生职业病杂志

The Second Affiliated Hospital of Shandong First Medical University treated a patient with oral sulfur mixture poisoning on January 14, 2020. The patient presented with cyanosis and disturbance of consciousness as the first manifestations, accompanied by metabolic acidosis, shock, hypercalcemia and severe liver function and myocardial damage. The patient was given active treatment, including gastric lavage, blood purification, methylene blue application, correction of shock, organ support and other therapies. However the treatment was poor. Finally, the patient's family chose to give up and requested to be discharged from the hospital, and the patient died on the same day after follow-up.

Análise crítica da indicação da lavagem gástrica em intoxicações atendidas em um hospital de ensino / Critical analysis of gastric lavage indication for poisoning cases attended in a university hospital

Objetivo: Avaliar a indicação da lavagem gástrica no tratamento de intoxicações causadas por ingestão. Métodos: Todos os casos de intoxicação causada por ingestão que foram atendidos em dois hospitais do interior de São Paulo e submetidos à lavagem gástrica no período de 1° de janeiro de 2011 a 31 de dezembro de 2015 foram avaliados retrospectivamente quanto à indicação do procedimento, considerando o tempo entre ingestão e atendimento, a toxicidade da substância e as contraindicações para o procedimento. Resultados: Dos 587 casos atendidos, 338 (57,6%) foram submetidos à lavagem gástrica. Dentre esses casos, constatou-se a realização equivocada do procedimento em 95,8% casos. Conclusão: O número de pacientes submetidos à lavagem gástrica neste trabalho foi considerado elevado, mesmo quando orientado pelo centro de atendimento. Apesar da falta de evidências de que a lavagem gástrica traga benefícios nos casos de intoxicação, ela é largamente utilizada em virtude do desconhecimento das indicações e contraindicações desse procedimento por parte dos profissionais de saúde

Objective: To evaluate the indication of gastric lavage in the treatment of poisoning caused by ingestion. Methods: All cases of poisoning caused by ingestion that were treated in two hospitals in inland cities of São Paulo and subjected to gastric lavage from January 1, 2011 to December 31, 2015 were retrospectively assessed as for the indication of the procedure, considering the time between ingestion and care, substance toxicity, and procedure contraindications. Results: Of the 587 cases treated, 338 (57.6%) underwent gastric lavage. The procedure was considered incorrect in 95.8% of cases. Conclusion: The number of patients undergoing gastric lavage in this study was considered high, even when instructed by the center of attendance. Despite the lack of evidence that gastric lavage brings benefits in cases of poisoning, it is widely used due to the lack of knowledge by health professionals of the indications and contraindications of this procedure.

Profile of intoxications served at the 24-hour emergency service unit

Intoxications represent a serious public health problem. According to the World Health Organization, 193,000 deaths per year are caused by unintended intoxications worldwide. This study aims to know the profile of intoxications at the 24-hour Emergency Service Unit in Divinópolis, in the state of Minas Gerais. This is a descriptive study in which the study population chosen were all patients treated for intoxications in the period from 2017 to 2018, registered in the health service; 421 cases of intoxications were recorded. The female gender was the most prevalent, and the age group with the most cases was 21 to 30 years. The main circumstance found was attempted suicide (83.1%), and the main causative agent was drugs (76.5%), with benzodiazepines being the main class responsible for intoxications. The most used treatment was gastric lavage and activated charcoal. This study demonstrates that knowledge about the city's intoxication profile is important for the development of treatment and patient management methods to better suit the demands of the municipality.

Evaluation of gastric lavage effi ciency and utility using a rapid quantitative method in a swine paraquat poisoning model / 世界急诊医学杂志（英文）

@#BACKGROUND: Gastric lavage (GL) is one of the most critical early therapies for acute paraquat (PQ) poisoning; however, details of the treatment protocol remain to be established. METHODS: A rapid quantitative method involving sodium dithionite testing was developed. It was validated for the determination of the PQ concentrations in gastric juice and eluate samples from a swine acute PQ poisoning model with early or delay GL, or without. The vital signs, laboratory testing, and PQ plasma concentrations were collected for therapeutic effect evaluation. RESULTS: The reaction conditions of the test were optimized for two types of samples. Early GL at one hour (H1) could improve the signs and symptoms after acute PQ poisoning at 24 hours (H24). In contrast, GL at 6 hours (H6) could only partially relieve the vital signs. The H1 GL group effectively reduced the peak of the plasma PQ concentration. In addition, the PQ concentrations in the plasma and the gastric juice were signifi cantly decreased in both the GL groups as compared to the untreated group at H24. Moreover, there was no signifi cant difference in the washing effi ciencies calculated from the total eluates between the two GL groups. However, the washing effi ciency of the fi rst 10 L eluate is superior to that of the additional 10 L eluate. CONCLUSION: GL only at early stage may it benefit PQ poisoning in an animal model. The currently used 20 L GL volume may need to be reduced in view of the low washing efficiency in the later 10 L eluate. The rapid quantitative method can be used for gastric juice sample and has a certain value for clinical GL practices.

The preventive effect of twin-tube laryngeal mask airway on gastric lavage and inhalation pneumonia in patients with toxic coma / 中华急诊医学杂志

Objective To explore the preventive effect of twin-tube laryngeal mask airway on gastric lavage and aspiration pneumonia. Methods Between January 2015 and June 2017, 305 cases of poisoning coma patients were admitted to Emergency Department, The First Affiliated Hospital of Nanchang University. According to the inclusion criteria and exclusion criteria, 255 cases of poisoning coma patients were enrolled and randomly(random number) divided into 3 groups (n=85 in each group):group A (normal gastric lavage machine method), group B (gastric lavage endotracheal intubation), and group C (gastric lavage twin-tube laryngeal mask airway placement). Whether there was aspiration pneumonia within 12 hours after the onset was observed, and the length of hospital stay, hospitalization cost and mortality were recorded. The mean value of the two samples was compared with t test, and the four-grid data were checked by chi-square test. P<0.05 was statistically significant. Results Compared with group A, the incidence of aspiration pneumonia was significantly lower in group B and group C (group A 56.47％, group B 32.94％, group C 23.53％, P<0.01). Compared with group A, the length of hospital stay in group C was shorter [(3.39±2.12) d vs. (6.06±4.91) d,P<0.05], and the hospitalization cost was less [(25687.52±20803.44) yuan vs. (52213.91±37267.56)yuan,P<0.05]. There was no significant difference of mortality between the three groups (P>0.05).Compared with group B, the length of hospital stay in group C was shorter [(3.39±2.12) d vs.(5.51±4.37) d, P<0.05], and the hospitalization cost was less [(25687.52±20803.44)yuan vs.(50887.82±32399.76) yuan, P<0.05]. There was no significant difference of mortality between the three groups (P>0.05). Conclusions Twin-tube laryngeal mask airway for poisoning coma patients with gastric lavage, can not only ensures effective ventilation, but also reduces the probability of concurrent aspiration pneumonia, shortens hospital stay, and reduces hospitalization cost, but has no obvious effect on mortality.

Clinical profile of childhood Tuberculosis in a Tertiary Care Rural Hospital and comparision of efficacy of daily vs intermittent chemotherapy

Introduction: Tuberculosis (TB) remains a major public health problem, despite noteworthy socioeconomic development and advances in medical science. It is a curable disease but still millions of people suffer every year and a number of them die from this infectious disease, resulting in devastating social and economic impact. We report the disease course, clinical profile and factors associated with treatment outcome in a tertiary facility of Waghodia. Materials and methods: The study was carried out in the Department of Pediatrics at Dhiraj Hospital, Piparia. Recruitment took place from February 2014 to February 2015. The clinical profile of 71 patients was studied and patients were followed up to 6 months to evaluate the treatment outcome. Results: There was preponderance of males (60.56%, n=43) in study population as compared to females (39.44%, n=28). Most of the patients were belonging to age group of <6 years (32.4%, n=23) and >10 years (38.0%, n=27). Among 6 to 10 years, 21 (29.6%) patients were included in study. Most common form of TB was extra-pulmonary TB (60.56%, n=43) followed by pulmonary TB (39.43%, n=28). Non-specific symptoms like fever (82.5%, n=66) was the commonest presenting symptoms. Other symptoms included cough (33.8%, n=24), altered sensorium (19.71%, n=14), swelling (15.5%, n=11). From all the patient with follow up (n=50), 44 (88.0%) were cured. Conclusion: Diagnosis of paediatric tuberculosis still continues to be a challenge. In the study TB was more common in extra-pulmonary than pulmonary forms in our setting. Diagnosis was based on a combination of epidemiological and clinical suspicion supported by results of various investigations. Aashish Sethi, Prasad Muley. Clinical profile of childhood Tuberculosis in a Tertiary Care Rural Hospital and comparison of efficacy of daily vs. intermittent chemotherapy. IAIM, 2018; 5(5): 69-78. Page 70 Presence of paediatric TB is an indication of prevalence of TB in that community. Extra pulmonary tuberculosis is more common in pediatric population and comparison of daily vs. intermittent treatment shows similar efficacy

Clinical analysis of emergency treatment of gastric lavage in patients with severe organophosphorus pesticide poisoning and psychological intervention after operation / 中国生化药物杂志

Objective To investigate the effect of gastric lavage under endotracheal intubation on first aid of severe organophosphorus pesticide poisoning patients and the value of psychological intervention. Methods 80 cases of patients with severe organophosphorus pesticide poisoning, underwent intubation gastric lavage, and randomly divided into conventional nursing (control group, n= 40) and psychological intervention (observation group, n= 40) contrast effect. Results The cholinesterase activity returned to normal time and hospitalization days in the observation group was less than that in the control group, and the compliance rate of the doctors and nurses was higher than that of the control group, and the psychological improvement was better than that of the control group, with statistical difference (P<0.05). Conclusion Emergency treatment of gastric lavage with endotracheal intubation in emergency organophosphorus pesticide poisoning patients at the same time, psychological intervention can significantly shorten the course of disease and improve prognosis.

Determination and comparative study on pH of esophagus and trachea in mice / 局解手术学杂志

Objective To detect and compare the pH value of different locations in esophagus and trachea of mice.Methods 40 male Kunming mice of clean grade were randomly divided into two groups,of which the esophagus(esophageal group) and trachea(windpipe group) were measured,before the experiment two groups kept 12 hours abrosia.The esophagus and trachea of the rats in two groups were dissected and separated out,the distance from the central incisors were 0.3 cm,0.5 cm,0.7 cm,the incision was like 'T'.The sensitive grade of pH test paper was used for the determination,and the data was recorded in each group and analyzed.Results All the mice were measured successfully.The pH of the esophagus group were (6.10±0.17),(5.84±0.11),(5.44±0.11),and the pH value of the trachea group were(7.44±0.11),(7.19±0.11),(6.97±0.07),respectively.There was a significant difference in the same segment between the two groups(P<0.05).Conclusion The results showed that the differences in the pH values of trachea and esophagus and the pH values of different segments,which provides a theoretical basis for the design of model mice by intragastric administration of pH to identify the value of trachea and esophagus.

Effect of saline lavage on patients with acute oral poisoning / 中国生化药物杂志

Objective To study and explore the clinical effect of saline lavage on patients with acute oral poisoning. Methods From January 2014 to January 2017, 100 cases of patients with acute oral drug poisoning who admitted in the emergency department of our hospital were selected as the research object, the patients were randomly divided into the control group and the observation group by taking digital computer random grouping method, 50 cases in each group, the control group used clean water to lavage, the observation group used saline to gastric lavage, the success rate of rescue, serum sodium concentration, mean arterial pressure and complication rate were compared between two groups. Results The success rate of rescur in the observation group was significantly higher than the control group (P<0.05); after gastric lavage, serum sodium concentration and mean arterial pressure in the observation group had not appear obvious fluctuation, and serum sodium concentration and mean arterial blood pressure in the control group were lower than those before gastric lavage (P<0.05); the incidence of complications in the observation group was significantly lower than that the control group (P<0.05). Conclusion The use of physiological saline for acute oral poisoning patients with gastric lavage, can effectively improve the success rate of rescue, reduce complications, but also to avoid water and electrolyte disorders.

A Successful Management after Cement Ingestion: A Case Report

Cases of the cement ingestion are rare. This paper reports the successful management of cement ingestion with gastric lavage and endoscopic washing. A 69-year-old man who had a stuporous mentality and seizures visited the local emergency room. He was found in his room with cement powder and several liquor bottles. He underwent a gastric lavage in the prior emergency room, which showed evidence of cement ingestion. He was transferred to the emergency center after primary care. Cement mixed with water is a strong alkali and acts as a caustic agent in the gastrointestinal tract. In addition, it can become hard in a few hours and sometimes produce gastric bezoars. Generally, gastric lavage is not recommended for caustic agents. On the other hand, gastric lavage and endoscopic washing was performed repeatedly for successful removal despite the physical and chemical characteristics of cement. Therefore, the active removal of ingested cement by both gastric lavage and endoscopic washing is recommended.

Clinical Profile of Childhood Tuberculosis in a Tertiary Care Rural Hospital

Introduction: Tuberculosis (TB) remains a major public health problem, despite noteworthy socioeconomic development and advances in medical science. It is a curable disease but still millions of people suffer every year and a number of them die from this infectious disease, resulting in devastating social and economic impact. TB treatment requires several months of swallowing a combination of 3 to 4 drugs every day. Patients often forget to take their medicines or stop taking them when they start to feel better. The Revised National TB Control Programme (RNTCP), based on the internationally recommended Directly Observed Treatment Short-course (DOTS) strategy was launched. Studies of paediatric TB are scantily available both in global and national context. Reliable data on the treatment of paediatric TB and its follow up are not available. Hence, a study of paediatric TB is designed to evaluate the clinical profile of childhood tuberculosis and following up the treatment outcome upto 6 months Materials and methods: The study was carried out in the Department of Pediatrics at Dhiraj Hospital, Piparia. Recruitment took place from February 2014 to February 2015. The clinical profile of 71 patients was studied. Results: There was preponderance of males (60.56%, n=43) in study population as compared to females (39.44%, n=28). Most of the patients were belonging to age group of <6 years (32.4%, n=23) and >10 years (38.0%, n=27). Among 6 to 10 years, 21 (29.6%) patients were included in study. Most common form of TB was extra-pulmonary TB (60.56%, n=43) followed by pulmonary TB (39.43%, n=28). Non-specific symptoms like fever (82.5%, n=66) was the commonest presenting symptoms. Other symptoms included cough (33.8%, n=24), altered sensorium (19.71%, n=14), swelling (15.5%, Muley P, Odedara T, Memon R, Sethi A, Gandhi D. Clinical Profile of Childhood Tuberculosis in a Tertiary Care Rural Hospital. IAIM, 2017; 4(6): 109-124. Page 110 n=11). From all, the patient with follow up (n=50), 44 (88.0%) were cured, 3 (6.0%) patients expired during the course of treatment, 3(6.0%) patient showed no improvement. Conclusion: Diagnosis of paediatric tuberculosis still continues to be a challenge. In the study TB was more common in extra-pulmonary than pulmonary forms in our setting. Diagnosis was based on a combination of epidemiological and clinical suspicion supported by results of various investigations. Presence of paediatric TB is an indication of prevalence of TB in that community. As the source of transmission of TB to children is usually an adult, control of tuberculosis in adult is necessary to decrease the prevalence of TB in children. DOTS is an effective strategy for treatment of TB.

Evidence-based practice of standardized gastric lavage for acute organophosphorus pesticide poisoning / 中华护理杂志

Objective To formulate standardized program of gastric lavage for acute organophosphorus pesticide poisoning(AOPP) and evaluate the effects.Methods Evidence was obtained via evidence-based approach,and recommendations were formed.The standardized program of gastric lavage for AOPP was formulated and then applied to clinical practice.The effects were evaluated by examining indicators of success rate of catheterization,the first time of gastric lavage,the time of atropinization and total usage of atropine,ChE recovery time,hospital stay,rebound rate,adverse event rate.Results After implementation,the first time of gastric lavage,the time of atropinization,total usage of atropine,ChE recovery time,and hospital stay were significantly lower than the control group (P＜0.05).Conclusion Evidence-based practice of gastric lavage for AOPP can improve therapeutic effects,reduce adverse reactions,improve quality of nursing,and promote safety of medical care.

Erythromycin infusion prior to endoscopy for acute nonvariceal upper gastrointestinal bleeding: a pilot randomized controlled trial

BACKGROUND/AIMS: The aim of this study was to compare the effects of erythromycin infusion and gastric lavage in order to improve the quality of visualization during emergency upper endoscopy. METHODS: We performed a prospective randomized pilot study. Patients presented with hematemesis or melena within 12 hours and were randomly assigned to the erythromycin group (intravenous infusion of erythromycin), gastric lavage group (nasogastric tube placement with gastric lavage), or erythromycin + gastric lavage group (both erythromycin infusion and gastric lavage). The primary outcome was satisfactory visualization. Secondary outcomes included identification of a bleeding source, the success rate of hemostasis, duration of endoscopy, complications related to erythromycin infusion or gastric lavage, number of transfused blood units, rebleeding rate, and bleeding-related mortality. RESULTS: A total of 43 patients were randomly assigned: 14 patients in the erythromycin group; 15 patients in the gastric lavage group; and 14 patients in the erythromycin + gastric lavage group. Overall satisfactory visualization was achieved in 81% of patients: 92.8% in the erythromycin group; 60.0% in the gastric lavage group; and 92.9% in the erythromycin + gastric lavage group, respectively (p = 0.055). The identification of a bleeding source was possible in all cases. The success rate of hemostasis, duration of endoscopy, and number of transfused blood units did not significantly differ between groups. There were no complications. Rebleeding occurred in three patients (7.0%). Bleeding-related mortality was not reported. CONCLUSIONS: Intravenous erythromycin infusion prior to emergency endoscopy for acute nonvariceal upper gastrointestinal bleeding seems to provide satisfactory endoscopic visualization.

Medico-legal knowledge assessment of interns and post graduate students in a medical institution

Background: Forensic Medicine and Toxicology is an essential subject for medical students as it deals mainly with legal aspects Aim and objectives: To assess medico legal knowledge and awareness in interns and post graduate students. Materials and methods: A cross-sectional, questionnaire with 15 questions was designed and distributed to 120 interns and 80 post graduate students from January 2015 to December 2015. The data was collected and analyzed statistically for number and percentage using EPI-Info statistical software version 6. Results: Total 200 students were included in our study. We found that 84 (70%) interns and 32 (40%) post graduate students had no proper knowledge in handling medico legal cases independently. 55 (45.83%) interns and 63 (78.75%) post graduate students were of opinion that the present UG teaching is not sufficient for them to tackle medico legal cases. Only 36 (30%) interns and 33 (41.25%) post graduate students were aware about the preservatives that are generally used for chemicals analysis of organs and 25 (20.83%) interns and 65 (81.25%) post graduate students were aware of Consumer Protection Act. Conclusion: We found that interns and post graduate students did not have sufficient knowledge about routine medico legal aspects and there is a need to bring awareness among them.

Develepment and application of the inserted mouth gag / 中国实用护理杂志

Objective To evaluate the effectiveness of mouth gag which can inserted into lavage tube during gastric lavage. Methods The Sixty- six cases of acute poisoning patients with gastric lavage according to random number table method were randomly divided into two groups, 33 cases in each group. Observation group used the inserted mouth gag, and the control group used the metal ones. Results The observation group were lower than the control group at the time required to insert the lavage tube [(2.23±0.19)s to (3.26±0.30)s] and the incidence of complication rate [18.2%(6/33) to 45.5%(15/33)], the oral cavity bleeding [6.0%(2/33) to 30.3%(10/33)], lavage tube displacement [0(0/33)to 24.2%(8/33)], lavage tube twisting[0(0/33) to 24.2%(8/33)], the difference was statistically significant (P<0.01), while higher in the rate of successful intubation[100.0%(33/33)] to [54.5%(18/33)], the difference was statistically significant, χ2=19.4,P<0.01. Conclusions The application of the mouth gag which can insert into gastric lavage improved the successful intubation rate, saved the rescue time, reduced the complication and improved the nursing quality.

Therapeutic effects of gastric lavage with fuller earth combined with QingyiⅡ catharsis in treatment of oral paraquat poisoning in rabbits / 中华危重病急救医学

ObjectiveTo observe the therapeutic effects of gastric lavage with fuller earth combined with QingyiⅡ catharsis in treatment of oral paraquat poisoning in rabbits.Methods Thirty healthy adult Japanese white rabbits were randomly divided into five groups: namely control group, model group, gastric lavage group (lavage of 10%fuller earth suspension), catharsis group (QingyiⅡ catharsis), and combination group (10 minutes after gastric lavage of fuller earth suspension liquid, giving QingyiⅡ for catharsis), with 6 rabbits in each group. All groups were challenged with paraquat (100 mg/kg) diluted to 5 mL with normal saline by lavage to reproduce the model of acute poisoning, while the control group was given 5 mL of normal saline instead. Each treatment group was treated accordingly at 1 hour after gavages of paraquat, and treatment continued for 3 days. The animal survival rate was observed. Venous blood samples were collected from ear marginal vein to determine the plasma concentration of paraquat by ultraviolet spectrophotometer at 1, 2, 4, 8 and 24 hours after the poisoning. The animals were sacrificed by intravenous air injection on the 8th day after the poisoning, and the right lower lobe of lung was harvested to observe the lung tissue pathological changes with hematoxylin-eosin (HE) staining.Results① Survival rate: the surviving rate of the combination group (6 rabbits) was higher than that of gastric lavage group (5 rabbits), catharsis group (2 rabbits) and model group (0 rabbit) on the 2nd day with statistically significant difference (P< 0.001). The survival rate on the 7th day in combination group (5 rabbits) was higher than that of gastric lavage group (3 rabbits), and catharsis group (0 rabbit) with statistically significant difference (P = 0.003).② Plasma concentrations of paraquat: plasma paraquat concentration in all groups peaked at 2 hours after intoxication, and its levels in the gastric lavage, catharsis and combination groups were significantly lower than that of the model group (mg/L: 1.830±0.068, 1.890±0.048, 1.800±0.052 vs. 1.960±0.063, allP< 0.01). As the time prolonged, the plasma concentration of paraquat was lowest in combination group than that of gastric lavage group and catharsis group (allP< 0.01). Gastric lavage and catharsis had interaction at 4 hours in combination group [F = 5.194,P = 0.034; the concentrations of paraquat (mg/L) was 0.670±0.057 vs. 1.010±0.018, 1.210±0.052].③ Lung histopathology: obvious expansion and hyperemia of the alveolar capillary, widened alveolar septum, a large number of inflammatory cell infiltrations were observed in model group and catharsis group. Lung histopathology was more improved in combination group and gastric lavage group, and it was improved more obviously in combination group than that in gastric lavage group.Conclusions Early start of gastric lavage with fuller earth combined with QingyiⅡ catharsis, can reduce the animal plasma concentrations of paraquat in oral paraquat poisoning rabbits. At the same time, it can alleviate the degree of lung injury and significantly improve survival rates compared with the single gastric lavage or catharsis alone. Gastric lavage with fuller earth combined with QingyiⅡ catharsis can improve the prognosis of animal synergistically.

Clinical Analysis of Acute Sedative/Hypnotic Intoxication by Route of Emergency Department Access

PURPOSE: The prevalence of intoxication and toxidromes, such as altered mental status, from Sedatives/hypnotics is high. Many patients have been transferred to a higher-level emergency center. This study was designed to analyze the clinical features of these patients and to compare patients transferred from a regional hospital with patients who directly visited a higher-level emergency center. METHODS: A retrospective study was conducted on 298 sedative/hypnotic intoxication patients examined from January 2008 to December 2012. After excluding patients intoxicated from other category medications and missing data on medical records, 158 acute intoxication patients were enrolled in the study and divided into transferred and direct-visit groups. Gastric lavage patients (n=108) were also subdivided into two groups by irrigation site. Clinical features, treatments, and complications were investigated. RESULTS: There were no significant differences between the two groups in initial clinical manifestations, laboratory data, and toxicological information, except for charcoal treatment and complications from pneumonia. The use of charcoal was significantly lower in the group transferred from a regional medical center. The transferred group showed a higher incidence of pneumonia than the direct-visit group (10/54(18.5%) vs. 5/104(4.8%), respectively, p=0.007). In the subgroup analysis of gastric lavage patients, there was also a higher incidence of pneumonia in the regional hospital lavage group compared to the higher-level emergency center lavage group (8/32(25.0%) vs. 5/76(6.6%), respectively, p=0.011). From a comparative analysis of pneumonic complications and mental status, pneumonia patients showed a higher incidence of painful responses and unresponsive mentality (6(40.0%) and 4(26.7%), respectively, p<0.001). CONCLUSION: In acute sedative/hypnotic intoxication patients, transferred patients, including regional hospital gastric lavage patients, showed a higher incidence of pneumonia. Pneumonic complication patients showed a higher incidence of a decreased mentality. Therefore, for patients transferred or treated for an altered mental status, precautions for complications from pneumonia must be considered.

Proper Understanding and Application of Gastric Lavage

Gastric lavage is one of gastrointestinal decontamination methods which have been controversial in the clinical toxicology field for a long time. Expert groups of American and European clinical toxicologists have published the position papers regarding gastric lavage three times since 1997. They recommended that gastric lavage should not be used as a routine procedure in the management of acute intoxication, because they thought that there is no certain evidence of improving clinical outcome by its use. However, the studies they reviewed were not well-controlled randomized trials, which cannot be conducted in the clinical toxicology field due to variability of patients and ethical problems. Therefore, the results from these studies should be interpreted with caution. They also insisted that gastric lavage can be undertaken within 60 minutes of ingestion. The limitation of one hour after ingestion is too arbitrary and may cause a lot of misunderstanding. Formation of pharmacobezoar or gastric hypomotility after ingestion may significantly delay the gastric emptying time so that gastric lavage can be useful even after several hours or more in case of highly toxic substances or severe intoxication. Furthermore, as there are a number of serious intoxication by toxic pesticides with large amount in suicidal attempts in Korea, it seems that gastric lavage may be used more frequently in Korea than in Western countries. When deciding whether or not to use gastric lavage, all the indications, contraindications, and possible adverse effects should be taken into account on the basis of risk-benefit analysis. If the procedure is decided to be done, it should only be performed by well-trained experts.

Lavagem gástrica realmente efetiva? / Gastric lavage - effective?

Método descrito pela primeira vez há pouco menos de 200 anos, a lavagem gكstrica é atual- mente utilizada na terapêutica de intoxicaçمo por grande variedade de substâncias, Este pro- cedimento visa à remoçمo da substância ingerida antes que esta atinja o intestino delgado, local de maior absorçمo; e vem sendo realizado de maneira bastante indiscriminada pelos profissionais da saْde. A técnica deve ser realizada em ambiente que ofereça adequadas condiçُes de suporte ao paciente frente às possيveis complicaçُes. Este artigo tem a intençمo de motivar a discussمo acerca da real eficكcia desta prكtica, além de trazer informaçُes ْteis sobre os reais benefيcios e desvantagens advindas da realizaçمo da lavagem gكstrica e de outras técnicas de descontaminaçمo do estômago...(AU)

Described for the first time less than 200 years ago, the gastric lavage method is performed nowadays in the therapeutics for intoxication by severa I kinds of substances. This procedure, which aims to remove the ingested substance before it reaches the small bowel, ploce of highest leveI of absortion; has been conducted in a fairly indiscriminate way by health professionals. It must be performed by well trained personnel in o proper facility, able to manage possible complications. This article is intended to encourage discussion about the real effectiveness of this practice, and provide useful information concerning real benefits and disadvantages arising from the performance of gastric lavage and other techniques for decontamination of the stomach, and, therefore, of the patient...