In which type of poisoning should irrigation (lavage) not be given?

NORCET 2 - 2021 (shift-1)

Medical Surgical Nursing

Easy

Appeared in: NORCET 2 - 2021 (shift-1)

Explanation

Gastric lavage is absolutely contraindicated in corrosive poisoning due to the high risk of perforating the already damaged esophagus or stomach.
The procedure involves passing a tube and flushing fluid, which can re-expose the upper gastrointestinal tract to the corrosive agent, causing further chemical burns.
Management of corrosive poisoning focuses on dilution (if safe), supportive care, and preparing for endoscopy, not on stomach emptying procedures like lavage or induced emesis.

Option A: While activated charcoal is often preferred for belladonna (anticholinergic) poisoning, gastric lavage is not absolutely contraindicated and may be considered if a massive, life-threatening amount was ingested within one hour and the patient's airway is protected.
Option B: For paracetamol poisoning, the standard of care is the administration of activated charcoal (if within 1-2 hours of ingestion) followed by the antidote N-acetylcysteine (NAC). Gastric lavage is rarely performed as it is less effective than charcoal and offers no benefit.
Option D: Food poisoning is typically managed with supportive care, such as hydration and antiemetics. Gastric lavage is not a routine treatment and is generally unnecessary, but it is not strictly contraindicated as it is in corrosive poisoning.

Visual 1: Diagram - A clear illustration of the gastric lavage procedure, labeling the orogastric tube, stomach, and flow of fluid, as seen in the question's image.
Visual 2: Infographic - A 'Do's and Don'ts' chart for managing corrosive poisoning, highlighting 'DO NOT induce vomiting' and 'DO NOT perform lavage'.
Visual 3: Endoscopic Images - Showing different grades of corrosive injury to the esophagus and stomach to help learners visualize the tissue damage that contraindicates lavage.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Contraindications for Gastric Lavage as background academic context rather than a clinical decision trigger.
A nurse's primary responsibility in a poisoning case is to 'first, do no harm.' Knowing absolute contraindications like avoiding lavage in corrosive ingestion is a critical patient safety competency.
The nursing priority is always to assess and stabilize the Airway, Breathing, and Circulation (ABCs) before any decontamination procedure is considered.
Nurses must be prepared to manage the complications of corrosive ingestion, such as airway edema, shock, and severe pain, and anticipate the need for urgent endoscopy.

How to Approach the Question

First, identify the negative keyword 'not' in the question stem. This means you are looking for the situation where the procedure is forbidden.
The question asks for a contraindication to gastric lavage (irrigation).
Recall the absolute contraindications for this procedure. The most critical ones are ingestion of corrosive substances and hydrocarbons due to the risk of perforation and aspiration, respectively.
Evaluate each option: Belladonna, Paracetamol, and Food poisoning do not pose the same risk of tissue perforation as corrosive agents.
Conclude that corrosive poisoning is the correct answer because it presents a direct and severe risk of iatrogenic injury (perforation) if lavage is attempted.

Concept Tested & Keywords

Concept Tested: Contraindications for Gastric Lavage
Stem keywords: poisoning, irrigation, lavage, not be given
Lead-in keywords: not
Negative lead-in flag: This question uses a negative framing ('NOT'), asking you to identify the exception or contraindication.

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