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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Saturday, November 14, 2015

HDA y lavado nasogástrico

Resultado de imagen de Emergency Medicine News
Runde, D - Emergency Medicine News: November 2015; 37 (11) - 20–21
doi: 10.1097/01.EEM.0000473175.23346.27 
..."Does NG lavage have any diagnostic value? Is it necessary for successful endoscopy? Does it result in any improved patient important outcomes? Even if it doesn't, it makes our consultants happy, so is there any reason not to just get it done? The answers are no, no, no, no, and hell yes, respectively. Let's tackle each question in turn.
Can NG lavage rule in or rule out acute UGIB? A review article inJAMA says if you get back blood or coffee grounds from your lavage, you have a +LR of 9.6, which isn't too shabby. (JAMA2012;307[10]:1072.) Unfortunately, this seems to represent an absolute best-case scenario because these data come from a single center, retrospective cohort study. A review published in Academic Emergency Medicine in 2010 was more extensive and reveals much less impressive results.
Summing Things Up
  • NG lavage has poor specificity and even worse sensitivity. Its diagnostic value is about the same as that Sacagawea dollar coin burning a hole in your pocket. 
  • It doesn't improve any important patient outcomes. 
  • It hurts. A lot. 
I'll leave you with a quote from an editorial in the journalGastrointestinal Endoscopy, “The jury is no longer out. NG lavage does not help patients in the emergency department with acute upper GI bleed.” (Gastrointest Endosc 2011;74[5]:981.)
I couldn't have said it better myself."