NORCET 2 - 2021 (shift-1)
Medical & Surgical Nursing
Easy
In which type of poisoning should irrigation (lavage) not be given?
Appeared in: NORCET 2 - 2021 (shift-1)
Explanation
- Corrosive poisoning is an absolute contraindication for gastric lavage.
- Corrosive agents (strong acids or alkalis) severely damage the lining of the esophagus and stomach, making them prone to rupture.
- Passing a lavage tube can cause iatrogenic perforation of the weakened gastrointestinal tract.
- The process of lavage can re-introduce the corrosive substance to the upper airway and esophagus, causing further burns.
- There is a very high risk of aspiration, leading to life-threatening chemical pneumonitis.
Why Other Options Were Wrong
- Option A: While not always the first choice, gastric lavage is not absolutely contraindicated for belladonna (anticholinergic) poisoning. It may be considered if performed within one hour of a large, life-threatening ingestion and the patient's airway is protected.
- Option B: For paracetamol (acetaminophen) poisoning, the preferred method of gastric decontamination is activated charcoal, not lavage. However, lavage is not absolutely contraindicated due to perforation risk; it is simply less effective and rarely used.
- Option D: In most cases of food poisoning, treatment is supportive (hydration, antiemetics) and self-limiting. Gastric lavage is not a routine procedure but is not strictly contraindicated. The main concern is fluid and electrolyte balance.
Related Visual
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 immediate recognition of corrosive ingestion (e.g., burns on lips/mouth, drooling, stridor) is critical to prevent harmful interventions like lavage or induced emesis.
- The priority nursing actions for corrosive poisoning are airway management (ABCs), stabilizing the patient, and preparing for emergency endoscopy, not gastric decontamination.
- What if? If a patient who ingested a corrosive substance is unconscious, the priority is to secure the airway via intubation, not to attempt gastric lavage. Any attempt at lavage would be extremely dangerous and likely fatal.
How to Approach the Question
- First, identify that the question is asking for a contraindication, which is a situation where a specific treatment should NOT be used. The keyword is 'not'.
- The procedure in question is gastric irrigation or lavage.
- Recall the absolute contraindications for gastric lavage. The most critical and universally taught contraindication is the ingestion of corrosive substances due to the high risk of perforating the esophagus or stomach.
- Evaluate each option against this knowledge:
- Belladonna & Paracetamol: Lavage is generally outdated and replaced by activated charcoal, but it's not absolutely forbidden due to perforation risk.
- Food Poisoning: Lavage is not a standard treatment, but it's not dangerously contraindicated.
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 lead-in ('not') to ask for a contraindication.
Question ID
Q65CmLaiY-QruTKrc0zd1K
Reference Book
E6 Medicine Harrison 22e Part 2 p. 1613-1615
E6 Nursing Brunner Adult Health 3SA Vol 2 Part 3 p. 129-131
E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 752-754
Practise the full NORCET 2 - 2021 (shift-1)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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