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E M Caravati - One of the best experts on this subject based on the ideXlab platform.
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position paper update Gastric Lavage for gastrointestinal decontamination
2013Co-Authors: B E Benson, Kalle Hoppu, W G Troutman, Regis Bedry, Andrew R Erdman, Jonas Hojer, Bruno Megarbane, Ruben Thanacoody, E M CaravatiAbstract:Context. The fi rst update of the 1997 Gastric Lavage position paper was published by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists in 2004. This second update summarizes the 2004 content and reviews new data. Methods. A systematic review of the literature from January 2003 to March 2011 yielded few studies directly addressing the utility of Gastric Lavage in the treatment of poisoned patients. Results. Sixty-nine new papers were reviewed. Recent publications continue to show that Gastric Lavage may be associated with serious complications. A few clinical studies have recently been published showing benefi cial outcomes, however, all have signifi cant methodological fl aws. Conclusions. At present there is no evidence showing that Gastric Lavage should be used routinely in the management of poisonings. Further, the evidence supporting Gastric Lavage as a benefi cial treatment in special situations is weak, as is the evidence to exclude benefi t in all cases. Gastric Lavage should not be performed routinely, if at all, for the treatment of poisoned patients. In the rare instances in which Gastric Lavage is indicated, it should only be performed by individuals with proper training and expertise.
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position paper update Gastric Lavage for gastrointestinal decontamination
2013Co-Authors: B E Benson, Kalle Hoppu, W G Troutman, Regis Bedry, Andrew R Erdman, Jonas Hojer, Bruno Megarbane, Ruben Thanacoody, E M CaravatiAbstract:Context. The first update of the 1997 Gastric Lavage position paper was published by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicol...
Jentaie Shiea - One of the best experts on this subject based on the ideXlab platform.
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rapid identification of psychoactive drugs in drained Gastric Lavage fluid and whole blood specimens of drug overdose patients using ambient mass spectrometry
2017Co-Authors: Chiwei Lee, Jentaie Shiea, Youda CaiAbstract:Psychoactive drug overdoses are life-threatening and require prompt and proper treatment in the emergency room to minimize morbidity and mortality. Prompt identification of the ingested psychoactive drugs is challenging, since witness recall is unreliable and patients' symptoms do not necessarily explain their loss of consciousness. Gas and liquid chromatography mass spectrometric analyses have been the traditionally employed methods to detect and identify abused substances; however, these techniques are time-consuming and labor-intensive. In this study, thermal desorption electrospray ionization mass spectrometry, an ambient mass spectrometric technique, was applied to rapidly characterize flunitrazepam, lysergic acid diethylamide, and 3,4-methylenedioxy-methamphetamine in drained Gastric Lavage fluid, and ketamine, cocaine, amphetamine and norketamine in whole blood samples. No pretreatment of the Gastric Lavage fluid specimens was required and the entire analytical process took less than 30 s per specimen. Liquid-liquid extraction, followed by centrifugation, was performed on the whole blood samples. The corresponding compounds were identified through matching the obtained mass spectrometric data with those provided by commercial databases. The limits-of-detection of the tested drugs in both drained Gastric Lavage fluid and whole blood samples are at sub ppm levels. This is sensitive enough for emergency medical application, since the quantities of medications ingested by overdosed abusers are much higher than the amounts that were tested.
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rapid point of care identification of oral medications in Gastric Lavage content by ambient mass spectrometry in the emergency room
2016Co-Authors: Chiwei Lee, Jentaie Shiea, Baihsiun Chen, Shyijang ShinAbstract:Rationale Acute poisoning should be handled with high efficiency in order to minimize morbidity and mortality in the emergency room. Unfortunately, history-taking and physical examination are not always reliable. Mis-swallowing of oral medications is common in the pediatric group. This study aimed at developing a rapid point-of-care ambient mass spectrometric method for the early identification of ingested oral medications in Gastric Lavage content. Methods Four different types of oral medications that are most commonly mis-swallowed by children were diluted to different concentrations. Each of these chemical solutions was mixed with human Gastric Lavage content. A direct metallic sampling probe was dipped into the solution. It was then inserted promptly into the thermal desorption electrospray ionization source to carry out ionization and subsequent mass spectrometric analysis of the medications. The corresponding compounds were identified through matching of the obtained mass spectrometric data with those provided by well-established databases. Results Since no pretreatment of the specimen was required, the sampling step, and the subsequent thermal desorption electrospray ionization and mass spectrometric detection of the medications were completed within 30 s. Mass spectra were obtained for four different kinds of oral medication. The limit-of-detection of the four tested oral medications in Gastric Lavage content is at sub-ppm level, which is sensitive enough for emergency medicine applications since the quantities of medications ingested by pediatric patients are usually much higher. Conclusions Thermal desorption electrospray ionization mass spectrometry, with informational support provided by an online mass spectral database, allows for early point-of-care identification of mis-swallowed oral medications in the evacuated Gastric Lavage contents obtained from Gastric Lavage of patients in the emergency room, and it is promising in providing important toxicological information to ensure the appropriateness of the subsequent medical management. Copyright © 2016 John Wiley & Sons, Ltd.
Helen Mcshane - One of the best experts on this subject based on the ideXlab platform.
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evaluation of xpert mtb rif assay in induced sputum and Gastric Lavage samples from young children with suspected tuberculosis from the mva85a tb vaccine trial
2015Co-Authors: Erick Wekesa Bunyasi, Michele Tameris, Hennie Geldenhuys, Beymarrie Schmidt, Angelique Kany Kany Luabeya, Humphrey Mulenga, Thomas J Scriba, Willem A Hanekom, Hassan Mahomed, Helen McshaneAbstract:Objective Diagnosis of childhood tuberculosis is limited by the paucibacillary respiratory samples obtained from young children with pulmonary disease. We aimed to compare accuracy of the Xpert® MTB/RIF assay, an automated nucleic acid amplification test, between induced sputum and Gastric Lavage samples from young children in a tuberculosis endemic setting. Methods We analyzed standardized diagnostic data from HIV negative children younger than four years of age who were investigated for tuberculosis disease near Cape Town, South Africa [2009–2012]. Two paired, consecutive induced sputa and early morning Gastric Lavage samples were obtained from children with suspected tuberculosis. Samples underwent Mycobacterial Growth Indicator Tube [MGIT] culture and Xpert MTB/RIF assay. We compared diagnostic yield across samples using the two-sample test of proportions and McNemar’s χ2 test; and Wilson’s score method to calculate sensitivity and specificity. Results 1,020 children were evaluated for tuberculosis during 1,214 admission episodes. Not all children had 4 samples collected. 57 of 4,463[1.3%] and 26 of 4,606[0.6%] samples tested positive for Mycobacterium tuberculosis on MGIT culture and Xpert MTB/RIF assay respectively. 27 of 2,198[1.2%] and 40 of 2,183[1.8%] samples tested positive [on either Xpert MTB/RIF assay or MGIT culture] on induced sputum and Gastric Lavage samples, respectively. 19/1,028[1.8%] and 33/1,017[3.2%] admission episodes yielded a positive MGIT culture or Xpert MTB/RIF assay from induced sputum and Gastric Lavage, respectively. Sensitivity of Xpert MTB/RIF assay was 8/30[26.7%; 95% CI: 14.2–44.4] for two induced sputum samples and 7/31[22.6%; 11.4–39.8] [p = 0.711] for two Gastric Lavage samples. Corresponding specificity was 893/893[100%;99.6–100] and 885/890[99.4%;98.7–99.8] respectively [p = 0.025]. Conclusion Sensitivity of Xpert MTB/RIF assay was low, compared to MGIT culture, but diagnostic performance of Xpert MTB/RIF did not differ sufficiently between induced sputum and Gastric Lavage to justify selection of one sampling method over the other, in young children with suspected pulmonary TB. Trial Registration ClinicalTrials.gov NCT00953927
Michael Eddleston - One of the best experts on this subject based on the ideXlab platform.
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systematic review of controlled clinical trials of Gastric Lavage in acute organophosphorus pesticide poisoning
2009Co-Authors: M L Tse, Nicholas A Buckley, Indika Gawarammana, Michael EddlestonAbstract:Background. Organophosphorus pesticide (OP) self-poisoning is a major problem in the developing rural world. There is little clinical trial data to guide therapy, hindering the identification of best therapy. Despite the recognition of adverse effects, Gastric Lavage is commonly done in Asia. We aimed to identify studies assessing its effectiveness. Method. We systematically searched the literature for controlled clinical studies that assessed the effect of Gastric Lavage in OP pesticide self-poisoning. Results. All 56 studies identified were Chinese and reported benefit from the intervention studied, including multiple Gastric Lavages, use of norepinephrine or pralidoxime in the Lavage fluid, concurrent treatment with naloxone or scopolamine, insertion of the Gastric tube via a laparotomy incision, and Lavage later than 12 h post-ingestion. However, only 23 were RCTs and none presented adequate methodology for their quality to be assessed. The patient population and study treatment protocol were not defi...
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the hazards of Gastric Lavage for intentional self poisoning in a resource poor location
2007Co-Authors: Michael Eddleston, Sapumal Haggalla, K Reginald, K Sudarshan, M Senthilkumaran, Lakshman Karalliedde, Ariaranee Ariaratnam, M Rezvi H Sheriff, David A Warrell, Nicholas A BuckleyAbstract:Objective. The 10–20% case fatality found with self-poisoning in the developing world differs markedly from the 0.5% found in the West. This may explain in part why the recent movement away from the use of Gastric Lavage in the West has not been followed in the developing world. After noting probable harm from Gastric Lavage in Sri Lanka, we performed an observational study to determine how Lavage is routinely performed and the frequency of complications. Case series. Fourteen consecutive Gastric Lavages were observed in four hospitals. Lavage was given to patients unable or unwilling to undergo forced emesis, regardless of whether they gave consent or the time elapsed since ingestion. It was also given to patients who had taken non-lethal ingestions. The airway was rarely protected in patients with reduced consciousness, large volumes of fluid were given for each cycle (200 to more than 1000 ml), and monitoring was not used. Serious complications likely to be due to the Lavage were observed, including ca...
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does Gastric Lavage really push poisons beyond the pylorus a systematic review of the evidence
2003Co-Authors: Michael Eddleston, Edmund Juszczak, Nicholas A BuckleyAbstract:Classically, treatment of acute self-poisoning involves resuscitation and supportive care, followed by Gastric emptying, administration of activated charcoal, and use of specific antidotes. Recently, however, the practice of Gastric emptying has fallen out of favor in the West because physicians have recognized its complications and the lack of evidence for clinical benefit from its practice. Authoritative position statements have stated that forced emesis should not be used and that Gastric Lavage should be used in restricted settings. One commonly cited complication of Gastric Lavage is propulsion of poison beyond the pyloric sphincter into the small bowel. We have carried out a systematic search for studies addressing this issue and found only 2. The first, a randomized controlled trial of patients presenting to an emergency department, reported propulsion of poison into the small bowel and has been widely cited as showing evidence for such a complication. However, analysis of the data presented in this article shows no significant difference in the number of radio-opaque marker pellets present in the small bowel after Gastric Lavage, ipecac-induced forced emesis, or no intervention. The second, an observational study using human volunteers, showed significantly less poison in the small bowel after Gastric Lavage than after no intervention. In conclusion, it seems that no published data support the statement that Gastric Lavage forces poison into the small bowel.
B E Benson - One of the best experts on this subject based on the ideXlab platform.
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position paper update Gastric Lavage for gastrointestinal decontamination
2013Co-Authors: B E Benson, Kalle Hoppu, W G Troutman, Regis Bedry, Andrew R Erdman, Jonas Hojer, Bruno Megarbane, Ruben Thanacoody, E M CaravatiAbstract:Context. The fi rst update of the 1997 Gastric Lavage position paper was published by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists in 2004. This second update summarizes the 2004 content and reviews new data. Methods. A systematic review of the literature from January 2003 to March 2011 yielded few studies directly addressing the utility of Gastric Lavage in the treatment of poisoned patients. Results. Sixty-nine new papers were reviewed. Recent publications continue to show that Gastric Lavage may be associated with serious complications. A few clinical studies have recently been published showing benefi cial outcomes, however, all have signifi cant methodological fl aws. Conclusions. At present there is no evidence showing that Gastric Lavage should be used routinely in the management of poisonings. Further, the evidence supporting Gastric Lavage as a benefi cial treatment in special situations is weak, as is the evidence to exclude benefi t in all cases. Gastric Lavage should not be performed routinely, if at all, for the treatment of poisoned patients. In the rare instances in which Gastric Lavage is indicated, it should only be performed by individuals with proper training and expertise.
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position paper update Gastric Lavage for gastrointestinal decontamination
2013Co-Authors: B E Benson, Kalle Hoppu, W G Troutman, Regis Bedry, Andrew R Erdman, Jonas Hojer, Bruno Megarbane, Ruben Thanacoody, E M CaravatiAbstract:Context. The first update of the 1997 Gastric Lavage position paper was published by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicol...