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Gag Reflex

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41. Foreign body aspiration

Foreign body aspiration Foreign body aspiration - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Foreign body aspiration Last reviewed: February 2019 Last updated: December 2017 Summary Inhalation of a foreign body into the larynx and respiratory tract. Symptoms include sudden onset of respiratory distress associated with coughing, gagging, or stridor. Unilateral wheezing suggests partial obstruction of the main (...) or distal bronchi. Major causes of foreign body aspiration are altered mental status from alcohol or sedative use; seizure; neurological disorders; trauma associated with a decreased level of consciousness; dental procedures; advanced or young age; disorders associated with dysphagia and impaired cough reflex. Flexible bronchoscopy confirms suspected cases of foreign body aspiration and can be used to attempt removal of the foreign body. Rigid bronchoscopy is performed if flexible bronchoscopy fails

2017 BMJ Best Practice

44. CRACKCast E181 – Approach to the Geriatric Patient

Focal Weakness Acute Focal Causes ICH Ischemic Stroke SAH Tumor Acute Bilateral Causes Brainstem stroke SCI trauma infection neoplasm inflammatory Guillain-Barre Non-Focal Weakness Acute Non-Focal Causes cardiac delirium metabolic infection Chronic Non-Focal Causes anemia meds inflammation neurologic deconditioning malignancy [6] List 8 predisposing risk factors for sepsis in the elderly. See Figure 183.4 Delirium and Dementia Decreased gag and cough reflex (aspiration risk) Endocrine deficiency

2018 CandiEM

46. CRACKCast E192 – Airway

in doubt, you can usually find weight ranges printed on the LMA! [4] Does presence of a gag reflex correlate with ability to protect an airway? Answer: No. It is important to note that the gag reflex is actually absent normally in approximately 25% of adults. The fact that it is not present does not indicate that an individual is unable to protect their airway. To truly assess an individual’s capacity to protect their airway, consider the following factors: The patient’s ability to voluntarily swallow (...) a quick overview! Common Induction Agents Etomidate Imidazole derivative Induction Dose: 0.3 mg/kg Pros: Does not impact hemodynamics Cons: Transient adrenal suppression. Ketamine Phencyclidine derivative Induction dose: 1-2 mg/kg Pros: Reaches clinical effect rapidly within 30 seconds, nearing peak effects at 1-minute Preserves protective airway reflexes and ventilatory drive Hemodynamically neutral Bronchodilatory effects- beneficial in the asthmatic patient Cons: Laryngospasm, emergence reactions

2018 CandiEM

47. CRACKCast E165 – Sedative Hypnotics

with birth defects (category D). [4] What are the clinical symptoms of barbiturate overdose? Mild toxicity Drowsiness slurred speech Ataxia unsteady gait Nystagmus emotional lability impaired cognition Severe Toxicity CNS depression = stupor to deep coma and respiratory arrest Pupils are usually normal or small and reactive hypoxia can cause pupils to be fixed and dilated Corneal and gag reflexes may be diminished or absent muscle tone = flaccid DTRs = diminished or absent Flexor (decorticate

2018 CandiEM

48. Perinatal substance use: neonatal

, brief opening of eyes at intervals, some sucking movements Deep—regular breathing, eyes closed, no spontaneous activity Hyperactive Moro reflex* Baby exhibits pronounced jitteriness of the hands during or at the end of the test for Moro reflex Markedly hyperactive Moro reflex* Baby exhibits jitteriness and repetitive jerks of the hands and arms during or at the end of the test for the Moro reflex Mild tremors when disturbed** Baby exhibits observable tremors of the hands or feet when being handled (...) a feed Poor feeding Baby either demonstrates excessive sucking prior to a feed, yet sucks infrequently during feeding, taking small amounts and/or demonstrates an uncoordinated sucking reflex or continuously gulps the milk and stops frequently to breathe Regurgitation Baby regurgitates not associated with burping 2 or more times during a feed Projectile vomiting Baby has =1 projectile vomiting episode occurring during or immediately after a feed Loose stools Scored if stool which may or may

2017 Queensland Health

49. Cranial Neuropathy

]. Tonsillar pain syndromes, palate weakness, and loss of gag reflex accompanied by loss of taste and sensation in the posterior pharynx may signal a glossopharyngeal nerve lesion [99]. ACR Appropriateness Criteria ® 13 Cranial Neuropathy MRI and CT As with the other cranial nerves, MRI of CN IX is the preferred modality for investigating possible lesions such as masses or vascular compression, with CT providing information on the bony integrity of the foramina [7,100- 103]. Imaging protocols should focus

2017 American College of Radiology

50. Does apnoeic oxygenation reduce the risk of desaturation in patients requiring endotracheal intubation?

This involves optimal patient positioning, oxygenation techniques and optimal intubation conditions. Waiting for paralysis prevents initiation of a gag reflex upon laryngoscopy and allows maximal laryngeal exposure, increasing chances of first-pass success.5 Apnoeic oxygenation allows oxygenation and ventilation of patients during the onset phase of muscle relaxation.5 During apnoea gas exchange between the alveoli and the bloodstream still occurs.5 It is estimated that 250 mL/min of oxygen diffuse

2017 BestBETS

51. CrackCAST E129 – Bacteria

Examination – The spatula test involves touching of the oropharynx with a tongue blade. With a negative test result, the patient gags and expels the tongue blade. With a positive test result, the patient has reflex masseter muscle spasm and bites the spatula. This test is 94% sensitive and 100% specific for tetanus. Management Aggressive supportive care Control muscle spasms Avoid unnecessary stimulation / loud noises = these can trigger severe spasms Treat spasms with benzodiazepines Diazepam – widely (...) , patients have decreased muscle tone and depressed deep tendon reflexes. Cranial nerve involvement causes alterations in facial expression, ptosis, and extraocular palsies. Respiratory failure occurs in 50% of patients. Fever is absent unless secondary infection is present. Hallmark signs: gastrointestinal, autonomic, and cranial nerve dysfunction. Bilateral cranial nerve involvement and the progression of neurologic findings should increase clinical suspicion. The diagnosis is confirmed by detection

2017 CandiEM

52. Standards for Conscious Sedation in the Provision of Dental Care

clinicians and patients in deciding on the best management and care of patients who are unable to receive routine care. Selection of the most appropriate pathway must be decided by patient need and some of these may be time- specific. Some of the issues involved are anxiety, a pronounced gag reflex, a traumatic procedure, the level of patient co-operation, the nature of the clinical care required and the time needed to deliver treatment. The options should be considered carefully and the selection at any (...) treatment is to be carried out and whether this will require a different provider. Where there are particular patient needs for the management of anxiety or other aspects that affect the individual’s ability to receive dental treatment (e.g. a pronounced gag reflex), referral to another provider may be in the patient’s best interests. When referring a patient, clear referrals must be made, the guidance described by the Dental Sedation Teachers Group should be followed 8 and the responsibilities

2015 Royal College of Anaesthetists

53. Equipment and Techniques in Adult Advanced Life Support

in cardiac arrest, but in the presence of a known or suspected basal skull fracture an oral airway is preferred. It is still necessary to use head tilt and jaw support, or jaw thrust [Class B; Expert consensus opinion]. Oropharyngeal airway Oral airways should be appropriately sized and not be forcibly inserted. They should be reserved for unconscious, obtunded victims. Laryngospasm or vomiting with aspiration may result in those patients who still have a gag reflex [Class B; Expert consensus opinion

2016 Australian Resuscitation Council

54. Techniques in Paediatric Advanced Life Support

or when the gag reflex is present. They are subject to dislodgment during transport. Their use should not replace mastery of bag-valve- mask ventilation. The LMA is a suitable means of providing ventilation in situations where bag-valve-mask ventilation has failed or is inadequate and ET intubation is not possible. Laryngeal mask airway sizes to suit body weight (kg) of newborns, infants and children are: size 1 100kg. Endotracheal intubation This technique is preferred for maintenance of the airway

2016 Australian Resuscitation Council

55. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome

during pelvic examina- tion. 18 Palpation of the levator muscles in both sexes, looking for tenderness, spasm/tight bands, and/or trigger points, is important for both diagnosis and treatment recommenda- tions; pelvic floor or rectal spasms may respond well to pelvic floor physiotherapy. Hypo or hypersensitivity of the perineum, in combination with a weak or absent anal reflex, may suggest pudendal nerve entrapment. A digital rectal examination (DRE) in men is essential, noting prostate (...) muscle dysfunction (pelvic floor examination is easily added to a cystoscopic examination) will direct treatment strategies. 8. Potassium sensitivity test (NOT RECOMMENDED, Grade C, Level 3 evidence) A potassium chloride bladder permeability test was based on the assumption that a “dysfunctional epithelium” (glycos- aminoglycan [GAG] layer) 37 allowed potassium ions to cross the abnormally permeable urothelium, depolarize nerves and muscles, and result in pain. The technique comparing subjec- tive

2016 Canadian Urological Association

56. Behavior Guidance for the Pediatric Dental Patient

oxide/oxygen inhalation is a safe and effective technique to reduce anxiety and enhance effective communication. Its onset of action is rapid, the effects easily are titrated and reversible, and recovery is rapid and complete. Additionally, nitrous oxide/oxygen inhalation mediates a variable degree of analgesia, amnesia, and gag reflex reduction. The need to diagnose and treat, as well as the safety of the patient and practitioner, should be considered before the use of nitrous oxide/oxygen (...) reaction threshold; — increase tolerance for longer appointments; — aid in treatment of the mentally/physically disabled or medically compromised patient; — reduce gagging; and — potentiate the effect of sedatives. • Indications: Indications for use of nitrous oxide/oxygen inhalation analgesia/anxiolysis include: — a fearful, anxious, or obstreperous patient; — certain patients with special health care needs; — a patient whose gag reflex interferes with dental care; — a patient for whom profound local

2015 American Academy of Pediatric Dentistry

58. Clinical practice guideline on Perinatal Hypoxic-Ischaemic Encephalopathy on Newborns

) at discharge was infrequent, occurring in 19 of 143 cases (13.2%). This condition was associated with an increased risk of unfavourable evolu- tion [OR = 8.47 (1.76-40.88)]. In children with significant encephalopathy at discharge, the presence of altered neurological signs (hypertonia, closed fists, abnormal movements, absence of the gag reflex and asymmetrical tonic reflex of the neck) increased the risk of death or disability [OR = 2.69 (1.09-6.67)]. Likewise, the need for tube feeding or a gastrostomy

2016 GuiaSalud

59. Nasojejunal (NJ) and orojejunal (OJ) management

opportunity ( ). NJ/OJ tubes - introduction Jejunal tube feeding is the method of feeding directly into the small bowel. The feeding tube is passed by the nose or mouth into the oesophagus, on into the stomach, through the pylorus and into the duodenum or jejunum. This type of feeding can also be known as duodenal, post-pyloric or trans-pyloric feeding. Some indications for use: absent gag reflex severe gastro oesophageal reflux delayed gastric emptying persistent vomiting ( ) Contraindications: upper GI

2015 Publication 1593

60. Shark Fin morphology recognized only by EM physician

with no clinical information and my immediate response was: "Shark fin! This patient is likely post-ROSC or peri-ROSC, right? LAD occlusion." I then sent it to Dr. Smith who said: "Just another shark fin. Should be obvious." The cath lab was activated immediately based on this ECG. iStat labs revealed hypokalemia of 2.2 mEq/L and pH 7.08 (VBG). He was given 300 mg rectal ASA and loaded with 4000U heparin. Soon after establishing a perfusing rhythm, the patient was gagging and coughing against the endotracheal (...) tube indicating intact brainstem reflexes. He had recurrent VFib several times requiring defbrillation with ROSC each time. Epinephrine drip was added for additional inotropy. The cardiology team arrived and another repeat ECG was obtained: Similar to first ECG. It has been 20 minutes since sustained ROSC, therefore the findings are likely not simply due to low flow during arrest (assuming the patient has had at least several minutes of at least decent coronary perfusion pressure, and this patient

2019 Dr Smith's ECG Blog

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