Betsy Lee PGY 3. o 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.

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Presentation transcript:

Betsy Lee PGY 3

o 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. o On exam, he has a GCS 8 with the presence of a gag reflex.

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

o 414 admissions for poisoning o 43 patients admitted IntubationNo Intubation Total GCS ≤ GCS > Total

IntubationNo Intubation Total Gag Reflex No Gag Reflex 260 Unknown448 Total

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

o 111 patients had GCS and gag assessed GCSAbsentWeakerNormal ≤

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

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

o Chan B, et al. “The Use of Glasgow Coma Scale in Poisoning.” The Journal of Emergency Medicine (1993) o Kulig K, et al. “Gag Reflex in Assessing Level of Consciousness.” The Lancet (1982) o Moulton C, et al. “Relation between Glasgow Coma Scale and the gag reflex.” BMJ. 303 (1991)