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Evidence in the ED Gag Reflex

Evidence in the ED Gag Reflex. Betsy Lee PGY 3. Case. 35 y/o M, h/o depression, comes to the ED with history of being found in bed with multiple empty pill bottles, unknown medications. On exam, he has a GCS 8 with the presence of a gag reflex.

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Evidence in the ED Gag Reflex

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  1. Evidence in the EDGag Reflex Betsy Lee PGY 3

  2. Case 35 y/o M, h/o depression, comes to the ED with history of being found in bed with multiple empty pill bottles, unknown medications. On exam, he has a GCS 8 with the presence of a gag reflex.

  3. Does the presence of the gag reflex mean that the patient is able to protect their airway?

  4. The Use of GCS in Poisoning 414 admissions for poisoning 43 patients admitted

  5. The Use of GCS in Poisoning

  6. Gag Reflex in Assessing Level of Consciousness Examined 38 patients on presentation to the ER that ranged from combative to comatose Used a tongue blade to assess for gag reflex 3 patients lacked a gag 35 patients had a gag – 6 had been intubated PTA, 12 obtunded 18 ER staff members then assessed 4 staff members lacked a gag

  7. Relation between GCS and Gag 111 patients had GCS and gag assessed

  8. Summary Absence of a gag reflex may be an indicator that a patient requires intubation However, presence of a gag reflex is not a useful piece of information 37% of healthy volunteers do not have a gag reflex

  9. HUPism: The presence or absence of a gag is not helpful information.

  10. References Chan B, et al. “The Use of Glasgow Coma Scale in Poisoning.” The Journal of Emergency Medicine. 11.5 (1993). 579-582 Kulig K, et al. “Gag Reflex in Assessing Level of Consciousness.” The Lancet. 1.8271 (1982). 565. Moulton C, et al. “Relation between Glasgow Coma Scale and the gag reflex.” BMJ. 303 (1991). 1240-1241.

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