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Gag Reflex

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181. Risk factors for unsuccessful prehospital laryngeal tube placement. (PubMed)

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

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

, 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

183. 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

185. Neurological History and Physical Examination (Overview)

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


186. Nutritional Management in the Rehabilitation Setting (Overview)

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


187. 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


188. Oral Examination (Overview)

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


189. Assessment of Neuromuscular Transmission (Follow-up)

weakness, which is exacerbated by exertion. Frequently, the pupillary light reflex is slowed (or even absent), and ophthalmoparesis may be present. Scoliosis or lordosis may also be present. The severity of the different symptoms varies considerably from patient to patient. The disease is caused by an autosomal recessive gene ( COLQ ; 603033) that codes for the collagen-like tail of endplate acetylcholinesterase. Histochemical stains show that acetylcholinesterase is absent from the nerve terminals


190. 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


191. Brain Death in Children (Follow-up)

brainstem function - Fixed and dilated or midposition pupils; absent spontaneous and oculocaloric/oculovestibular eye movements; absent movement of facial and oropharyngeal muscles; and bsent corneal, gag, cough, sucking, and rooting reflexes Spinal cord reflex withdrawal not included Consistent examination throughout the observation period (see Table 1, below) Table 1. Age-Dependent Observation Period Age Hours Between 2 Examinations Recommended Number of EEGs 7 days-2 months 48 2 2 months-1 year 24 2 (...) of the remaining patients; therefore, generalizations concerning age could not be made. The report concluded that ECS together with complete unresponsiveness, apnea, absent cephalic reflexes, and the inability to maintain circulation without artificial means is strongly presumptive of irreversible coma (ie, cerebral death). [ , ] The term electrocerebral inactivity (ECI) is often used instead of ECS. Previous Next: Harvard Medical School Ad Hoc Committee In 1968, a consensus report of the Ad Hoc Committee


192. Snoring and Obstructive Sleep Apnea, Upper Airway Evaluation

pressure (see Flexible Nasopharyngoscopy). Micrognathia can be a life-threatening pathology in some patients, such as those who have Pierre-Robin syndrome. In certain circumstances, temporary glossopexy may need to be performed to avoid asphyxia until a secure airway is obtained. Hypopharynx Examination of the hypopharynx requires the use of a laryngeal mirror, flexible endoscope, or a magnifying laryngoscope. A gag reflex that is very intense is a common problem in some patients and can make

2014 eMedicine Surgery

193. Snoring and Obstructive Sleep Apnea, Prosthetic Management

of sleep. Soft-palate, tongue, mandibular devices Oral appliances can advance the soft palate, tongue, or mandible, thus opening the airway. However, devices that advance the soft palate are seldom employed, most likely because of stimulation of the gag reflex and discomfort. Devices that advance the tongue alone are also rarely used, probably for similar reasons and because of the success of adjustable oral appliances. During obstructive apneas, the collapsed pharynx prevents airflow, which leads (...) in this musculature and loss of compensatory reflex dilator mechanisms during deep sleep result in the airway obstruction. [ , , ] Snoring, a common symptom of SDB, is a repetitive sound caused by vibration of upper airway structures during sleep. Snoring is a good indicator of increased upper airway resistance. Patients who have obstructive sleep apnea (OSA) generally have smaller upper airways than normal individuals. Increased parapharyngeal fat, a large tongue, an elongated palate, thickened lateral

2014 eMedicine Surgery

194. Stroboscopy

because of its magnified bright image; however, it requires extracting the patient's tongue forward throughout the examination, which distorts the natural phonatory posture of the pharynx and larynx. Moreover, the patient must have suitable anatomy and the physical tolerance (gag reflex) to allow the clinician to visualize the entire glottis. Rigid endoscopy additionally requires increased patient cooperation and amenable patient anatomy for successful visualization of the larynx. Recent research has

2014 eMedicine Surgery

195. Assessment of Neuromuscular Transmission (Overview)

weakness, which is exacerbated by exertion. Frequently, the pupillary light reflex is slowed (or even absent), and ophthalmoparesis may be present. Scoliosis or lordosis may also be present. The severity of the different symptoms varies considerably from patient to patient. The disease is caused by an autosomal recessive gene ( COLQ ; 603033) that codes for the collagen-like tail of endplate acetylcholinesterase. Histochemical stains show that acetylcholinesterase is absent from the nerve terminals


196. Heart Preservation (Diagnosis)

respirations (apnea) No oculovestibular reflexes No oculocephalic reflexes No corneal and pupillary reflexes No cough and gag reflexes Identifiable cause for the coma Irreversibility over a 12- to 24-hour observation period Cause of death In patients who become cardiac donors in urban United States, the usual mechanism of brain death is penetrating or blunt head trauma. Most deaths in these patients are secondary to motor vehicle collisions, gunshot wounds to the head, or . Intracranial bleeding, drug

2014 eMedicine Pediatrics

197. The Polytraumatized Patient (Overview)

spontaneously, listen to the quality of the breathing. Snoring or gurgling suggests partial airway obstruction. A hoarse voice, subcutaneous emphysema of the anterior part of the neck, or a palpable thyroid cartilage crepitus may indicate laryngeal trauma. Assess the ability of an unconscious victim to protect the airway by checking the gag reflex. Touch the posterior pharynx with a tongue blade to initiate the gag response. If the patient is alert, the best way to check for the ability to protect (...) the airway is to witness swallowing. Patients without a gag reflex cannot protect themselves from aspirating secretions into the lungs; these patients should be intubated. Treatment The jaw-thrust maneuver may be necessary. The most common airway obstruction is due to the base of the tongue falling backward into the posterior pharynx. The jaw thrust is performed by placing the fingers behind the angle of the mandible and lifting anteriorly. This is uncomfortable and may awaken an obtunded patient

2014 eMedicine Surgery

198. Lung Abscess, Surgical Perspective (Diagnosis)

, anesthesia, seizures Immunocompromised host - Steroid therapy, chemotherapy, malnutrition, multiple trauma Esophageal disease - Achalasia, reflux disease, depressed cough and gag reflex, esophageal obstruction Bronchial obstruction - Tumor, foreign body, stricture, enlarged lymph nodes Generalized sepsis Persistent vomiting Mechanical ventilation, tracheostomy Intravenous drug use Infected central venous catheters Previous Next: Prognosis The prognosis of patients with lung abscesses depends (...) with alcoholism and those with chronic illnesses frequently have oropharyngeal colonization with gram-negative bacteria, especially when they undergo prolonged endotracheal intubation and receive agents that neutralize gastric acidity. A pyogenic lung abscess can also develop from aspiration of infectious material from the oropharynx into the lung when the cough reflex is suppressed in a patient with gingivodental disease. Abscesses generally develop in the right lung and involve the posterior segment

2014 eMedicine Surgery

199. Lung Transplantation (Follow-up)

is determined by clinical criteria when two separate examinations are performed 24 hours apart or by ancillary studies to assess brain activities. An absence of drugs, hypothermia, or metabolic derangements must be confirmed. Clinical criteria for brain death are as follows: Known cause of condition Temperature higher than 95°F No drug intoxication or neuromuscular blocking agent No significant metabolic derangement No gag, cough, or corneal reflexes Absence of dull-eye reflex Pupils fixed and dilated

2014 eMedicine Surgery

200. Head Trauma (Follow-up)

response to painful stimulation. Test for pupillary response to light. Test for corneal reflex. Test for oculocephalogyric reflex (doll’s head reflex). Test for vestibulo-ocular reflex (caloric test). Test for upper and lower airway stimulation (eg, pharyngeal and endotracheal suction). Test for gag reflex. Perform apnea test. This test should be the last test and should be conducted after two clinical examinations (separated by the mandatory observation period) have confirmed the absence of brainstem (...) assessment must be excluded. Subsequently, the physical examination must show complete unresponsiveness, absent motor responses, absent brainstem reflexes, and apnea. Further confirmatory studies, such as EEG or cerebral blood flow studies, may be ordered if there is any ambiguity in the clinical evaluation. A typical brain death protocol may be summarized as follows: Confirm that the patient is in a coma. Evaluate the patient for seizure activity and decerebrate or decorticate movements. Test for motor

2014 eMedicine Surgery

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