Gastric wash contraindicated in:
**Core Concept**
Gastric lavage, also known as stomach pumping, is a medical procedure used to remove contents from the stomach. It is contraindicated in certain situations due to the potential for causing more harm than good. The underlying principle being tested is the appropriate use of gastric lavage in clinical scenarios.
**Why the Correct Answer is Right**
Gastric lavage is contraindicated in patients with a decreased level of consciousness, as they are at risk of aspiration during the procedure. This is because the gag reflex is impaired, making it difficult to protect the airway. Additionally, gastric lavage may cause vomiting, which can lead to aspiration pneumonia in these patients. The correct answer is related to the risk of aspiration, which is a critical consideration in the use of gastric lavage.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because gastric lavage is not contraindicated in patients with a history of peptic ulcer disease. In fact, it may be indicated in certain cases, such as in the presence of a foreign body or ingested toxin.
**Option B:** This option is incorrect because gastric lavage is not contraindicated in patients with a history of gastrointestinal surgery. The procedure may be used cautiously in these patients, depending on the specific circumstances.
**Option C:** This option is incorrect because gastric lavage is not contraindicated in patients with a history of gastrointestinal bleeding. In fact, it may be indicated in certain cases, such as in the presence of a foreign body or ingested toxin.
**Clinical Pearl / High-Yield Fact**
The American College of Medical Toxicology (ACMT) recommends that gastric lavage be performed only in certain situations, such as when a patient presents within 1 hour of ingestion of a toxic substance and is awake and alert. This is because the procedure is most effective when performed early and in patients who are at low risk of aspiration.
**Correct Answer:** D. Patients with a decreased level of consciousness.