II. Precautions
- Gastric Lavage should not be used routinely (if at all) in Poisonings
- In rare cases, when indicated, it should only be used by those trained in proper technique
III. Indications
- Rarely indicated in modern emergency medicine
- Poor efficacy
- Significant Nasal Trauma from large bore tubes (36-40 french Ewald tubes)
- Consider in Overdoses that approach 100% mortality (consult poison control)
- Colchicine Overdose
- Paraquat Poisoning (herbacide typically used outside the U.S., although some pockets of rural U.S. use)
- Hydrofluoric Acid (lethal Hyperkalemia and Hypocalcemia)
- Swaminathan and Nordt in Herbert (2018) EM:Rap 18(5):10-11
- Historically used in severe ingestion cases
IV. Contraindications
- Insignificant Overdose
- Corrosive Ingestion (strong acid or alkali)
- Hydrocarbon Ingestion (high aspiration risk)
- Minimally effective if given >1 hour post-ingestion
- Increased risk of Gastrointestinal Bleeding or perforation
- Unprotected airway (e.g. Altered Level of Consciousness)
V. Complications
VI. Preparations
- Activated Charcoal in aqueous solution (preferred due to lower Emesis, aspiration risk)
- Activated Charcoal in Sorbitol
VII. Technique
- Consider Endotracheal Intubation in advance
- Indicated for neurologic Impairment
- Use a large bore tube (28 French Ewald tube)
- Larger tubes however cause considerable Nasal Trauma
- Position patient
- Head down
- Left lateral decubitus
- Technique
- Aspirate first prior to fluid lavage
- Instill lavage fluid into Stomach
- Adult 100-300 cc warm water or Normal Saline per wash
- Child 10-15 cc/kg warm Normal Saline per wash
- Aspirate fluid back and dispose of fluid
- Repeat lavage
- Repeat until aspirate clears of pill fragments and similar debris of concern
- Single dose is sufficient in many cases
- If repeated, alternate aqueous and Sorbitol charcoal preparations every 2 hours