Lavage or not to lavage – hazards due to deviation from National Guidelines

Abstract

Self-poisoning with organophosphorus (OP) compounds has contributed to a large number of deaths in the developing world over many decades. While, most deaths are due to the inherent properties of the OP compounds, an important sub group of patients die due to iatrogenic causes, prevention of which will reduce death rates. In most developing countries, there is no continuous medical education of doctors who deliver primary care in rural villages which lead to iatrogenic deaths and disability. We present two patients who presented unconscious to primary care units following ingestion of OP compounds. Both patients received gastric lavage by medically unqualified personnel, with unprotected airways and without informed consent. Both patients were transferred to a specialized unit with an unprotected airway and both aspirated gastric contents which lead to mechanical ventilation and prolonged hospital stay. In both cases, the medical management deviated from accepted good clinical practice and National Guidelines. Reducing deaths from pesticide self-poisoning would require a coordinated effort involving new antidote development and optimizing medical care given to these patients at both primary and tertiary care units. Minimizing iatrogenic causes of morbidity and mortality would require a National approach at undergraduate and postgraduate levels. New mechanisms to improve knowledge of resuscitation, airway management and adherence to good clinical practice by primary care doctors should be initiated.