What to do when gastric contents are regurgitated through the nasal cavity?

From the Guidelines

When gastric contents are regurgitated through the nasal cavity, immediate action should be taken to clear the nasal passages and prevent further irritation, by tilting the head forward and gently blowing the nose, followed by rinsing the mouth with water and using a saline nasal spray or solution to flush the nasal passages, as recommended by general medical principles and supported by the most recent and highest quality studies available, such as 1.

Initial Steps

To manage the situation effectively, the following steps should be taken:

• Tilt the head forward to prevent further gastric contents from entering the nasal cavity
• Gently blow the nose to clear the nasal passages
• Rinse the mouth with water to remove any remaining vomit and spit it out
• Use a saline nasal spray or make a saline solution by dissolving 1/4 teaspoon of salt in 8 ounces of warm water to gently flush the nasal passages and remove irritants

Importance of Prompt Action

Prompt rinsing of the nasal passages is crucial to prevent further irritation and potential infection, as the acidic nature of vomit can irritate nasal tissues, as noted in general medical knowledge and supported by studies such as 1.

Additional Considerations

It is also important to drink small sips of water afterward to soothe the throat and monitor for any signs of infection, such as fever or colored discharge, in the days following the incident, and seek medical attention if necessary, as recommended by general medical principles and supported by studies such as 1 and 1.

Prevention of Future Incidents

In patients who are at high risk of regurgitation of gastric contents, such as those undergoing rapid sequence intubation, gastric decompression with a nasogastric tube may be advised, as recommended by the Society of Critical Care Medicine clinical practice guidelines 1.

From the Research

Gastric Contents Regurgitated through the Nasal Cavity

When gastric contents are regurgitated through the nasal cavity, it is essential to follow proper treatment protocols to prevent further complications.

• The study 2 suggests that the patient should be placed in a head-down position in the right lateral decubitus position to facilitate drainage of vomit from the airway.
• Suction and laryngoscopy may be necessary to clear the airway, and bronchoscopy may be required if the patient is asphyxiated by solid material.
• Endotracheal intubation may be necessary if the patient has aspirated liquid, and high-inspired oxygen and artificial ventilation may be required if the patient's oxygen levels are low.
• The use of steroids, such as hydrocortisone or dexamethasone, may be beneficial in reducing inflammation, and aminophylline may be used to treat bronchospasm.
• Plasma or plasma substitutes may be administered to treat hypotension and hypovolemia, and acidosis should be corrected.

Nasal Irrigation and Saline Sprays

Nasal irrigation with saline solutions may be beneficial in relieving symptoms of upper respiratory tract infections, as suggested by the studies 3, 4.

• The use of sea salt-derived physiological saline nasal sprays has been shown to improve nasal congestion, runny nose, sleep quality, and appetite in adults with upper respiratory infections 3.
• Saline nasal irrigation may also reduce the severity of symptoms associated with acute upper respiratory tract infections, although the evidence is limited by the small size and low quality of the included trials 4.

Antimicrobial Mouthwashes and Nasal Sprays

The use of antimicrobial mouthwashes and nasal sprays has been proposed as a potential treatment for COVID-19 infection, but there is currently limited evidence to support their effectiveness, as noted in the study 5.

• The study 5 found no completed studies that evaluated the benefits and harms of antimicrobial mouthwashes and nasal sprays in patients with suspected or confirmed COVID-19 infection.
• However, several ongoing studies are investigating the use of antimicrobial mouthwashes and nasal sprays in this context, and their results may provide further insight into the potential benefits and harms of these interventions.

Future Research Directions

Further research is needed to determine the clinical and cost-effectiveness of nasal sprays and physical activity and stress management interventions in reducing respiratory tract infections, as outlined in the study 6.

• The "Immune Defence" randomized controlled trial aims to evaluate the effectiveness of a gel-based nasal spray, a saline nasal spray, and a digital intervention promoting physical activity and stress management in reducing the incidence and severity of respiratory tract infections in primary care.