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Gag Reflex

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41. 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

43. 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

44. 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

45. 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

46. 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

47. 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

48. 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

50. 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

51. 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

52. How “they” view “us”: Colton Berrett edition

to wait until I stopped gagging. She actually said that?? The first picture I saw brought to mind this thought: Those girls look just like my daughter’s friend X who suffered and almost died from anorexia when she was in her teens. If I hadn’t known her and her parents and what they were all going through, but just saw her somewhere, I would probably have contacted the proper authorities. I didn’t think anything my opinion of the individual identifying as “Quackenboss” could go any lower, but I

2018 Respectful Insolence

53. Whatever happened to Dr. Daniel Neides, a year after he was forced to leave the Cleveland Clinic because of his antivaccine rant?

already had a history of being a bad apple. Only a select few were allowed access to it. She couldn’t go on record for various reasons, and she got slapped with some kind of gag. She left critical care to put in IVs all day long in a small-town hospital. This is why I left that world. Eric Lund I was asked to help investigate the director of the cancer center to reinforce some existing suspicions that he had plagiarized some grant proposals he was reviewing. They also suspected he was pressuring

2018 Respectful Insolence

54. Masitinib mesylate (Alsitek) - Amyotrophic Lateral Sclerosis

include spasticity and exaggerated reflexes (hyperreflexia) including an overactive gag reflex. An abnormal reflex commonly called Babinski’s sign (the large toe extends upward as the sole of the foot is stimulated in a certain way) also indicates upper motor neuron damage. Symptoms of lower motor neuron degeneration include muscle weakness and atrophy, muscle cramps, and fasciculations. To be diagnosed with ALS, people must have signs and symptoms of both upper and lower motor neuron damage

2018 European Medicines Agency - EPARs

55. Vestronidase alfa (Mepsevii) - Mucopolysaccharidosis VII

EU European Union FDA Food and Drug Administration FVC Forced vital capacity GAG Glycosaminoglycan GCP Good Clinical Practice GEE Generalized Estimating Equation GLP Good Laboratory Practice GMP Good Manufacturing Practice GUS Beta-glucuronidase HS Heparan sulfate HSCT Haematopoietic stem cell transplantation IAR Infusion associated reaction Assessment report EMA/480950/2018 Page 5/87 ICH International Conference on Harmonisation ICR Individualized clinical response IND Investigational New Drug (...) of action Vestronidase alfa is a recombinant form of human GUS and is intended to provide exogenous beta- glucuronidase for uptake into cellular lysosomes. Mannose-6-phosphate (M6P) residues on the oligosaccharide chains allow binding of the enzyme to cell surface receptors, leading to cellular internalization of the enzyme, targeting to lysosomes and subsequent catabolism of accumulated GAGs in affected tissues. Primary and Secondary pharmacology A summary of the effect of vestronidase alfa treatment

2018 European Medicines Agency - EPARs

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

57. Palliative care - secretions

the bronchiolar surfaces and cause inflammation of the mucosa, which triggers copious mucus production [ ]. Gastric reflux may also cause pooling of fluid in the hypopharynx [ ]. Oropharyngeal or gastric contents may be aspirated into the larynx and lower respiratory tract. Factors predisposing to aspiration include impaired consciousness, old age, impaired cough or gag reflex, and structural diseases of the airway and upper gastrointestinal tract. People who aspirate may have recurrent episodes of choking

2017 NICE Clinical Knowledge Summaries

58. Resuscitated from ventricular fibrillation: what is the ECG Diagnosis?

hour down time prior to being resuscitated. She has been without sedation for several hours and has no corneal or gag reflexes per the primary team. There is enough evidence to call into question her neurological viability at this time, thus a left heart catheterization would be of questionable utility.” Autopsy, day 7: Anoxic brain injury with total cerebral necrosis 99% stenosis of the proximal LAD, with acute transmural infarct of the anterior and anterolateral walls of the LV 75% stenosis LCx

2016 Dr Smith's ECG Blog

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 Great Ormond Street Hospital

60. Recommendations for the Management of Cerebral and Cerebellar Infarction with Swelling

physiological parameters, but early extubation in patients with a decompressive craniectomy for cerebellar infarcts can be problematic because of abnormal oropharyngeal function, lack of strong cough, and copious thick secretions. 90 The presence of a cough and gag reflex and normal eye movements may predict successful extubation. 91 Airway and Mechanical Ventilation: Recommendations 1. Maintaining normocarbia is reasonable (Class IIa; Level of Evidence C). 2. Intubation may be considered for patients (...) infarction, a decrease in level of consciousness occurs as a result of brainstem compression and therefore may include early loss of corneal reflexes and the development of miosis. Standardized definitions should be established to facilitate multicenter and population-based studies of incidence, prevalence, risk factors, and outcomes. Identification of patients at high risk for brain swelling should include clinical and neuroimaging data. If a full resuscitative status is warranted in a patient

2014 Congress of Neurological Surgeons

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