Transcript Evidence gag reflex Lee

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
Intubation
GCS ≤ 8
37
No
Intubation
18
Total
GCS > 8
4
334
338
Total
41
352
393
55
Intubation
Gag Reflex
11
No
Intubation
348
Total
No Gag
Reflex
Unknown
26
0
26
4
4
8
Total
41
352
393
359
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
3 patients lacked a gag
o 35 patients had a gag – 6 had been intubated PTA,
12 obtunded
o
o 18 ER staff members then assessed
o 4 staff members lacked a gag
o 111 patients had GCS and gag assessed
GCS
Absent
Weaker
Normal
13-15
6
16
30
9-12
4
8
10
≤8
17
16
4
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. 11.5 (1993). 579-582
o Kulig K, et al. “Gag Reflex in Assessing Level of
Consciousness.” The Lancet. 1.8271 (1982). 565.
o Moulton C, et al. “Relation between Glasgow
Coma Scale and the gag reflex.” BMJ. 303 (1991).
1240-1241.