A patient presents following a potentially serious oral poisoning. Assess whether gastric lavage is appropriate, identify contraindications and safety precautions, demonstrate the procedure on the provided mannequin if indicated, and explain the management and follow-up advice to the patient or family.

Indication: Gastric lavage is not routine. It may be considered exceptionally after a potentially life-threatening ingestion, usually within one hour, following specialist risk–benefit assessment.

Contraindications: Unprotected airway, corrosive ingestion, high-aspiration-risk hydrocarbons or significant gastrointestinal bleeding/perforation risk.

Technique: Stabilize ABCs, ensure airway protection, position appropriately and demonstrate controlled gastric aspiration and lavage through a suitable orogastric tube on the mannequin.

Complications: Aspiration, hypoxia, airway injury, gastrointestinal perforation and fluid/electrolyte disturbances.

Counselling: Explain the limited benefits and potential risks, required observation, treatment plan, warning symptoms and follow-up, including psychosocial assessment where appropriate.

1. Assess and stabilize: Ensure staff safety, summon senior/toxicology assistance and assess ABCs, consciousness, oxygenation and circulation. Treat immediate life-threatening problems first.
2. Decide whether lavage is justified: Establish the substance, estimated amount, time and route of ingestion. Consider lavage only in exceptional, potentially life-threatening recent ingestions after expert advice.
3. Exclude contraindications: Check airway protective reflexes and assess for corrosive ingestion, aspiration-prone hydrocarbons, gastrointestinal bleeding or perforation risk. An unprotected airway must not undergo lavage.
4. Prepare the mannequin: Explain the procedure and consent process. Demonstrate PPE, suction, monitoring, appropriate large-bore orogastric tube and lavage equipment. Position the mannequin in the left lateral position where appropriate, with airway management equipment available.
5. Demonstrate the procedure: In the supervised simulation, show measurement and gentle passage of the tube, confirmation of gastric rather than respiratory placement, initial aspiration and controlled small-volume aliquot instillation followed by drainage according to institutional protocol. Monitor fluid recovery.
6. Identify complications: Monitor for coughing, desaturation, aspiration, bleeding, abdominal pain and hemodynamic deterioration. Stop the procedure if complications are suspected and reassess immediately.
7. Counsel patient and family: Explain why lavage is or is not appropriate, expected monitoring, possible antidotes/supportive treatment and the need to report breathing difficulty, persistent vomiting, confusion or worsening symptoms.
8. Document and arrange follow-up: Record the ingestion history, clinical findings, decision and consent, procedural details if performed, complications and treatment plan. Arrange relevant toxicology, medical and mental-health follow-up where indicated.

⚠️ Critical patient-safety point: Gastric lavage should not be performed routinely in poisoned patients. Its clinical benefit is unproven, even after early potentially lethal ingestion. Never perform lavage in an unconscious patient without a protected airway, or after corrosive or high-aspiration-risk hydrocarbon ingestion.

Gastric Lavage Procedure Algorithm — Practical Skills Demonstration

A procedural demonstration to help visualize gastric lavage equipment and technique. Review critically alongside current toxicology recommendations, which discourage routine gastric lavage and require strict contraindication screening and airway precautions.

▶ Watch Gastric Lavage Practical Demonstration