Hotobhaga
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15) A 17-year-old girl is found unconscious in a bathroom after ingesting a large amount of unknown sleeping pills. On arriving at the emergency department, she is somnolent; her temperature is 37.2 C (98.9 F), blood pressure is 120/74 mm Hg, pulse is 68/min, and respirations are 12/min. She responds to painful stimuli and to hearing her name loudly by opening her eyes briefly. However, she returns to the somnolent state immediately afterward. Which of the following is the most appropriate initial intervention?
A. IV administration of caffeine
B. IV administration of droperidol
C. IV administration of 500 mL of normal saline
D. Ipecac-induced emesis
E. Gastric lavage
Explanation:
The correct answer is
E. Gastric lavage should be used in this somnolent patient. It is best done within the first 60 minutes of ingestion of the unknown substance. It is performed by inserting a large-caliber orogastric tube and then flushing the tube with a large amount of normal saline. The saline is then aspirated from the stomach to a container in an attempt to evacuate any ingested substance that persists in the stomach cavity. Identification of the ingested substance is also very important. With certain ingested substances, gastric lavage is contraindicated. For example, the procedure should not be used if hydrocarbon ingestion is suspected because aspiration is much more likely to happen during a lavage or an induced emesis. Furthermore, ingestion of alkaline substances causes esophageal necrosis. In this case, gastric lavage may cause esophageal perforation. IV administration of caffeine (choice B) has not been shown to be effective in reversing the mental status changes in patients who ingest a large amount of sleeping pills. Droperidol (choice C) is an antiemetic and is not an appropriate initial treatment in toxic ingestion. However, it may be used in conjunction with activated charcoal to enhance tolerance. IV administration of a normal saline bolus (choice D) plays no role in this patient who is normotensive aAand does not appear to be dehydrated or in shock. Ipecac-induced emesis (choice E) is a poor choice, because the mental status of the patient is impaired and there is a risk of aspiration when emesis occurs.
The time that has elapsed post injestion is not known( no benifit after 3 hours). Also the patient is somnolent.. more chances of aspiration.
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| elitoki
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I agree with gastric lavage, but the air way must be protected first.
E sounds the best answer in this case.
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| ssrpk
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hotobhaga, among the other options which one would you choose??? 
Edited by ssrpk on 07/05/07 - 01:53 AM. Reason: No ALL CAPS pls..this is a forum rule....agree
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| dr in trouble
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yes--gastric lavage shud b done.
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| young_doc
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Hotobhaga, it's always the "BEST" answer...and not necessarily the textbook "right" answer.
Amongst the options presented to us, it's the best one.
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