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Gag Reflex

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181. Cardiopulmonary Syndromes

and obtund the gag reflex, and anaphylactic reactions to preservatives in these solutions have been documented. Opioid and nonopioid antitussives, such as dextromethorphan, may act synergistically, but further studies are required to confirm this hypothesis.[ ] Gabapentin was found to be efficacious compared with placebo for chronic refractory cough, although this study did not specifically include cancer patients.[ ] In cases of increased sputum production, expectorants and mucolytics have been employed

2012 PDQ - NCI's Comprehensive Cancer Database

182. Cadaveric donation: brain stem death

maintained on mechanical ventilators. Brain stem death is diagnosed by performing, on two separate occasions, five simple tests which verify that: (1) the pupils are fixed and dilated and do not react to light; (2) there is no eye movement; (3) there is no ear reflex; (4) there is no pain response; and, (5) there is no gag reflex. Globally, brain death is clinically adjudged as the death of an individual. It is a clinical declaration of death whereby an individual’s life is clinically considered to have (...) their cardio-respiratory system is continuously maintained on mechanical ventilators. Brain stem death is diagnosed by performing, on two separate occasions, five simple tests which verify that: (1) the pupils are fixed and dilated and do not react to light; (2) there is no eye movement; (3) there is no ear reflex; (4) there is no pain response; and, (5) there is no gag reflex. Globally, brain death is clinically adjudged as the death of an individual. It is a clinical declaration of death whereby

2015 Evidence-Based Nursing blog

183. Jeffrey Aronson: When I use a word . . . Medical onomatopoeia

borborygmi in the chest have been reported in . To gag is to strangle or suffocate, imitating the sound made in choking. Hence, the gag reflex. By transference, a gag is something used to stop up the mouth or to keep the jaws open during surgery. Gagging for air is choking, but, in case you thought we’d worked back up the body again, gagging for it is being desperate for something altogether different. Jeffrey Aronson is a clinical pharmacologist, working in the Centre for Evidence Based Medicine

2015 The BMJ Blog

184. Determining brain death in adults

of the temporomandibular joints and deep pressure at the supraorbital ridge should produce no grimacing or facial muscle movement. Absence of the pharyngeal and tracheal reflexes. The pharyngeal or gag reflex is tested after stimulation of the posterior pharynx with a tongue blade or suction device. The tracheal reflex is most reliably tested by examining the cough response to tracheal suctioning. The catheter should be inserted into the trachea and advanced to the level of the carina followed by 1 or 2 suctioning (...) integrity ensured) □ Oculovestibular reflex absent □ No facial movement to noxious stimuli at supraorbital nerve, temporomandibular joint □ Gag reflex absent □ Cough reflex absent to tracheal suctioning □ Absence of motor response to noxious stimuli in all 4 limbs (spinally mediated reflexes are permissible) Apnea testing (all must be checked) □ Patient is hemodynamically stable □ Ventilator adjusted to provide normocarbia (PaCo 2 34–45 mm Hg) □ Patient preoxygenated with 100% FiO 2 for > 10 minutes

2010 American Academy of Neurology

185. The AMA acts to try to rein in doctors spreading misinformation

being "muzzled" or "gagged" is utter nonsense. Medical professional societies have the right—no, the duty—to uphold professional standards, and this is all that the AMA is trying to do. In the overall scheme of things, the AMA's action probably won't do much by itself. But if it serves as a start, an action that inspires other professional societies and—dare I dream it?—even state medical boards to follow suit, it could have a real impact. Imagine, for instance, not just Dr. Oz facing professional (...) about vaccines. And if that jibes with any of a number of different confirmation biases you might have, your guard goes up without thinking too much about it: Maybe there's something to this! I don't want to take a chance with my kid! Nobody gets measles anymore anyway! Better safe than sorry... As long as this mental process stays in the background, it can proliferate. Pull it all up to the front of consciousness, really look into it past the reflex phase, and it's a very different story. Too often

2015 Respectful Insolence

186. Bupivacaine Lozenge Compared with Lidocaine Spray as Topical Pharyngeal Anesthetic before Unsedated Upper Gastrointestinal Endoscopy: A Randomized, Controlled Trial. Full Text available with Trip Pro

Bupivacaine Lozenge Compared with Lidocaine Spray as Topical Pharyngeal Anesthetic before Unsedated Upper Gastrointestinal Endoscopy: A Randomized, Controlled Trial. Unsedated upper gastrointestinal endoscopy (UGE) can induce patient discomfort, mainly due to a strong gag reflex. The aim was to assess the effect of a bupivacaine lozenge as topical pharyngeal anesthetic compared with standard treatment with a lidocaine spray before UGE. Ninety-nine adult outpatients undergoing unsedated (...) diagnostic UGE were randomized to receive either a bupivacaine lozenge (L-group, n = 51) or lidocaine spray (S-group, n = 42). Primary objective was assessment of patient discomfort including acceptance of the gag reflex during UGE. The L-group assessed the discomfort significantly lower on a visual analog scale compared with the S-group (P = 0.02). There was also a significant difference in the four-point scale assessment of the gag reflex (P = 0.03). It was evaluated as acceptable by 49% in the L-group

2014 Clinical medicine insights. Gastroenterology Controlled trial quality: uncertain

187. Safety and Efficacy of CDFR0612 and CDFR0613 for Bowel Cleansing Before Colonoscopy

) disturbance Severe dehydration risk (e.g., rhabdomyolysis, ascites) Dialysis or renal disorder (creatinine clearance <15ml/min) Suspected pulmonary aspiration or gag reflex disorder History of hypersensitivity of drug or others Alcohol or drug abuse within 6 months Clinically significant underlying disease or medical history at investigator's discretion Inability in written/verbal communication Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study

2014 Clinical Trials

188. The effect of chewing lidocaine soaked gauze on intubation conditions during awake videolaryngoscopy: a randomised controlled trial in the morbidly obese. (Abstract)

The effect of chewing lidocaine soaked gauze on intubation conditions during awake videolaryngoscopy: a randomised controlled trial in the morbidly obese. The increasing utilisation of the videolaryngoscope for awake tracheal intubation requires development and assessment of methods to decrease the gag reflex. We hypothesised that chewing gauze soaked with lidocaine would decrease the gag reflex during awake videolaryngoscope tracheal intubation. Twenty four morbidly obese patients assessed (...) as having a potential difficult tracheal intubation were randomised to chew gauze soaked with 20 ml of 2% lidocaine or saline for 3 minutes. All patients then received 20 ml of aerosolised 2% lidocaine and underwent awake videolaryngoscope assisted tracheal intubation. Gagging scores, heart rate and blood pressure were assessed when best laryngeal view was obtained, when the tracheal tube was positioned at the cords, and when the tube was advanced into the trachea. In addition, serum lidocaine levels

2014 Acta anaesthesiologica Belgica Controlled trial quality: uncertain

189. An analysis of moderate sedation protocols used in dental specialty programs: a retrospective observational study. (Abstract)

, and other information that was recorded.The reasons for the use of moderate sedation were anxiety (54%), local anesthesia failures (15%), fear of needles (15%), severe gag reflex (8%), and claustrophobia with the rubber dam (8%). The most common medical conditions were hypertension (17%), asthma (15%), and bipolar disorder (8%). Most patients were classified as American Society of Anesthesiologists class II. More women (63.1%) were treated than men (36.9%). The mean age was 45 years. Monitoring

2014 Journal of Endodontics

190. Incident and Extent of Pulse Alteration During Local Anesthesia in Children

aberrant event which may occur during alteration of the pulse rate such as gag reflex, coughing, or pain related disruptive behavior will be documented on the computer in real time by another person that is not the treating dentist. All types of local anesthesia delivery will be performed by the computerized-controlled local anesthesia delivery system - Single-Tooth-Anesthesia which connected to a computer and documents continuously the amount and velocity of the local anesthetic delivered

2014 Clinical Trials

191. Clinical impact of gastroenterologist-administered propofol during esophagogastroduodenoscopy: a randomized comparison at a single medical clinic. Full Text available with Trip Pro

and four levels of the gag reflex, respectively. For safety purposes, endoscopists and nurses were trained in administering propofol and an anesthesiologist was on call at all times.No statistically significant differences were found between the two groups in sedation level and patient tolerability. Full recovery time in the propofol group (4.7 min) was significantly shorter than that in the midazolam group (24 min, P < 0.01).Regarding post-procedure management of patients in a medical clinic, propofol

2014 Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association Controlled trial quality: uncertain

192. Risk factors for unsuccessful prehospital laryngeal tube placement. (Abstract)

in 15.1% of first attempts and 9.9% of cases overall. The majority (79.2%) of first attempts occurred as a rescue airway after unsuccessful endotracheal intubation attempt(s), in patients with non-traumatic complaints (70.9%) and in cardiac arrest (60.8%). Gag reflex (OR 4.08, 95% CI 1.72-9.67), ground (versus air) EMS agency (OR 2.49, 95% CI 1.07-5.79), and male gender (OR 1.90, 95% CI 1.04-3.46) were associated with unsuccessful LT placement in our multivariable model.The laryngeal tube (...) is an effective airway management tool for both advanced life support and critical care prehospital providers. Gag reflex, ground (versus air) EMS agency, and male gender were associated with unsuccessful laryngeal tube placement by prehospital personnel.Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

2014 Resuscitation

193. Basilar Artery Thrombosis (Follow-up)

involvement of lower cranial nerves and impairment of consciousness in patients with brainstem ischemia. Other important aspects include assessment of the respiratory drive, the gag reflex, and the ability to handle secretions by a forceful cough. Ventilation Generally, endotracheal intubation should be considered in patients with a decreased level of consciousness and Glasgow Coma Scale score of less than 8. Endotracheal intubation is recommended in most patients to keep their airway clear while (...) therapy should address the concerns of aspiration in patients with profound dysarthria and depressed cough reflex. Diet The patient should be restricted to taking nothing by mouth until his or her swallowing mechanism has been assessed and cleared and the airway has been protected. If the patient has a high risk of aspiration, a nasogastric or nasoduodenal tube should be placed. If the swallowing abnormalities are so severe that recovery is expected to take weeks or months, a gastrostomy tube should

2014 eMedicine.com

194. Nutritional Management in the Rehabilitation Setting (Diagnosis)

Access Indication Advantages Disadvantages Nasogastric Requires intact gag reflex, normal gastric motility/gastric outlet Low cost, easy placement, easy removal Increased risk of aspiration/tube dislodgement Nasoduodenal/ nasojejunal High aspiration risk, delayed gastric emptying, gastroparesis, gastric dysfunction resulting from trauma or surgery Beneficial for lower incidence of nosocomial pneumonia Requires endoscopy or fluoroscopy for placement, increased risk of tube migration/dislodgement

2014 eMedicine.com

195. Lung Abscess (Diagnosis)

the following risk factors: Periodontal disease Seizure disorder Alcohol abuse Dysphagia Other patients at high risk for developing lung abscess include individuals with an inability to protect their airways from massive aspiration because of a diminished gag or cough reflex, caused by a state of impaired consciousness (eg, from alcohol or other CNS depressants, , or encephalopathy). Infrequently, the following infectious etiologies of pneumonia may progress to parenchymal necrosis and lung abscess

2014 eMedicine.com

196. Nursing Home Acquired Pneumonia (Diagnosis)

to acquiring pneumonia. Prevention of NHAP Keep patients who are predisposed to aspiration pneumonia in a semiupright position at night. Additionally, take care when feeding patients who have an empiric gag reflex or neurologic disorder that depresses consciousness or interferes with swallowing. Dysphagia has been identified as a risk factor, so nurses and other healthcare workers should be vigilant for signs of dysphagia to help prevent NHAP. [ ] Previous Next: History and Physical Examination Patient (...) history Patients may report fever, cough, chest pain, or rapid respiration. Patients with are particularly prone to developing pneumonia Patients with aspiration NHAP often have a history of central nervous system (CNS) or esophageal disease, or they have a decreased gag reflex that predisposes them to recurrent aspiration. Physical examination Most, but not all, patients are febrile. Fever, when present, may be low grade. Physical examination findings in the chest include rales over the involved lung

2014 eMedicine.com

197. Neurological History and Physical Examination (Diagnosis)

of the transverse colon. The vagus provides secretomotor fibers to the glands in the same region and inhibits the sphincters of the upper GI tract. Along with visceral sensation from the same region, the nerve participates in vasomotor regulation of blood pressure by carrying the fibers of the stretch receptors and chemoreceptors (ie, aortic bodies) of the aorta and providing parasympathetic innervation to the heart. The pharyngeal gag reflex (ie, tongue retraction and elevation and constriction (...) the following: Higher functions Cranial nerves (CNs) Sensory system Motor system Reflexes Cerebellum Meninges System survey Tools required In addition to the stethoscope and the usual office supplies (eg, gloves, tongue depressors), the neurologist should have an ophthalmoscope, a reflex hammer, and a tuning fork. A pin (Wartenberg) wheel was once a favorite tool of many neurologists because it was easy to use for sensory (pinprick) testing. Unless it is disposable (commercially available), this wheel

2014 eMedicine.com

198. Oral Examination (Diagnosis)

the posterior tongue with a tongue blade and instructing the patient to say "Ahhh." Deviation of the soft palate to one side or the other may indicate a neurologic problem or an occult neoplasm. Once the posterior tongue has been depressed and the patient has elevated the soft palate, examining the oral pharynx is possible. This can occasionally be complicated in patients who have a hyperactive gag reflex; however, in such cases, the gag reflex can be suppressed through the use of topical anesthetics (...) be confirmed with its signs and symptoms, a biopsy of the oral soft tissues with an histopathological examination is warranted. [ ] Intraoral photography with digital camera should be used to document mucosal lesions and evaluate the progression of the disease and responses to therapy. This typically requires 35-mm single lens reflex cameras with macro lens and ring flash attachment. Several models are available for intraoral photos. For patient education resources, see the patient education articles

2014 eMedicine.com

199. Nursing Home Acquired Pneumonia (Overview)

to acquiring pneumonia. Prevention of NHAP Keep patients who are predisposed to aspiration pneumonia in a semiupright position at night. Additionally, take care when feeding patients who have an empiric gag reflex or neurologic disorder that depresses consciousness or interferes with swallowing. Dysphagia has been identified as a risk factor, so nurses and other healthcare workers should be vigilant for signs of dysphagia to help prevent NHAP. [ ] Previous Next: History and Physical Examination Patient (...) history Patients may report fever, cough, chest pain, or rapid respiration. Patients with are particularly prone to developing pneumonia Patients with aspiration NHAP often have a history of central nervous system (CNS) or esophageal disease, or they have a decreased gag reflex that predisposes them to recurrent aspiration. Physical examination Most, but not all, patients are febrile. Fever, when present, may be low grade. Physical examination findings in the chest include rales over the involved lung

2014 eMedicine.com

200. Botulism (Overview)

, dysphagia, and/or suppressed gag reflex Additional neurologic manifestations include symmetrical descending paralysis or weakness of motor and autonomic nerves Respiratory muscle weakness may be subtle or progressive, advancing rapidly to respiratory failure The autonomic nervous system is also involved in botulism, with manifestations that include the following: Paralytic ileus advancing to severe constipation Gastric dilatation Bladder distention advancing to urinary retention Orthostatic hypotension (...) Reduced salivation Reduced lacrimation Other neurologic findings include the following: Changes in deep tendon reflexes, which may be either intact or diminished Incoordination due to muscle weakness Absence of pathologic reflexes and normal findings on sensory and gait examinations Normal results on mental status examination See for more detail. Diagnosis A mouse neutralization bioassay confirms botulism by isolating the botulinum toxin. Toxin may be identified in the following: Serum Stool Vomitus

2014 eMedicine.com

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