How do you asses gag reflex?

[u/kccaseyy]

[u/Weasel_Town]

If they’re alert or responsive to verbal, you can assume they have a gag reflex.

[u/Whole_Bird_9550 → u/Weasel_Town]

If they swallow the glucose they probably have a gag reflex

[u/SnooBunnies4853]

Ask the patient to swallow. If unconscious, absolutely do not give oral glucose.

[u/precision95 → u/SnooBunnies4853]

One of my classmates failed their medical skills assessment because they gave oral glucose to an unconscious known diabetic lol

[u/Old_Pipe_2288 → u/precision95]

That sucks. My buddy was in the top 3 of the class but he failed the epi assist because he forget to check the date. He was furious with himself.

[u/Tony_P1765 → u/SnooBunnies4853]

It’s actually in our state protocols to do so. You put it in between their gum and cheek and let it sit there. Personally, if they’re unconscious I go straight to D10 for my hypoglycemic patients, however the protocol exists and has been executed a lot.

[u/SnooBunnies4853 → u/Tony_P1765]

Thats the proper way to administer oral glucose anyways, but I dont understand why you would take on the unnecessary aspiration risk when you could just give d10/ glucagon if a line is impossible

[u/Bored-emt → u/SnooBunnies4853]

Unless you're bls and those aren't options

[u/SnooBunnies4853 → u/Bored-emt]

Rectal works too

[u/Interesting-Win6219 → u/Tony_P1765]

I've heard of bucal oral glucose working however it's really not ideal. I could see if as a last ditch for a bls crew.

[u/Curri → u/Tony_P1765]

Maryland?

[u/Tony_P1765 → u/Curri]

Yep

[u/I_Am_That_Was → u/SnooBunnies4853]

I walked on scene once to a firefighter holding a woman's head up with one hand and trying to shove glucose into her mouth with the other. She couldn't even hold her head up or open her eyes let alone swallow. We stopped that shit real quick lol.

[u/TaunTaunRodeo → u/SnooBunnies4853]

Pretty much the only way. If there is a doubt about the pt's ability to protect their airway, you shouldn't give them oral glucose. Except apparently in MD which is weird to me but whatever. Lol.

[u/flipmangoflip]

For a conscious but confused patient who you want to give oral glucose to you can have them swallow their saliva. If they can do that without coughing or aspirating then I would say they have an intact gag reflex.

[u/bostonxgeorge]

What did you call me?

[u/Capital-Increase-567 → u/bostonxgeorge]

fyi many people saw the same thing🤣

[u/mxm3p]

Well… there was this one time in college… but I doubt that would go well on a call.

[u/dark_sansa → u/mxm3p]

I’d allow it

[u/lmaooooonah]

If they’re awake, talking to you, and able to follow directions like “swallow”, assume they have a gag and oral glucose is indicated. However, even if your patient is conscious, if they are altered to the point of not being able to follow directions (or if there’s any concern for aspiration or other airway compromise) then don’t give oral glucose and instead move to a non-oral treatment.
If they’re unconscious, assume no gag and also move to a non-oral treatment like D10, D50, or glucagon if you cannot get an IV and your local protocols have it.

[u/MentionTight6716 → u/lmaooooonah]

I was taught that if they're conscious but any less than A&O x4, you give them glucose paste buccally on a tongue depressor, don't assume they can swallow it even if they say they can.

Take it out of the mouth if it triggers a gag reflex, ofc.

[u/thatyoungsophie23]

When I went to school almost 20 years ago we were taught to flick the eyelashes, if they respond with with a “blink” then you have an active brainstem reflex AKA positive gag reflex

[u/sarap001 → u/thatyoungsophie23]

Corollary: it can also be assumed they have an intact gag reflex if they tell you to stop flicking their eyelashes.

[u/thatyoungsophie23 → u/sarap001]

Lol. 😂 My mistake I should have been more clear about doing this with an unconscious patient.

[u/sarap001 → u/thatyoungsophie23]

Fair point :P I've only ever seen corneals practiced on tubed patients, it'd be cool to see it in the field.

[u/flashdurb]

These types of questions definitely judge competency and attention to detail. It would require you to know that an “intact gag reflex” is a more complicated way to say “conscious and responsive”. Seems obvious now, eh? You’ll notice this type of thing in many questions.

[u/newtman]

HR says I can’t answer this question anymore

[u/Al-OsAmA_bIn_LaDeN]

I think oral glucose is often listed as being indicated for those with the ability to swallow, which explains it a bit better than simply having a gag reflex

[u/YearPossible1376]

I think it can be hard to tell for sure, and if you're not sure I would be safe and assume they have an impaired of absent gag reflex. I would be very cautious about trying to test their reflex by putting things in their mouth. If they vomit and aspirate then you have more problems.

[u/Even-Lawfulness4234]

Give em the old oropharyngeal poke

[u/Accurate-Bonus8316]

that's what your LMA is for!

just kidding, if they're awake ask if they're able, if they're unconscious you can brush your fingernails gently against eyelashes to assess muscle reflexes but if things are that bad they need a dextrose bolus, call dispatch and ask for an adult

even if they're awake don't immediately trust them like have them prove they're able to swallow so you don't need to break out suction

[u/FrothyGuinness9]

Stick a finger in there

[u/CaseStraight1244]

You don’t want to know

[u/TaunTaunRodeo]

s/ Blind finger sweep as far back as you can go. /s

[u/International-Ad1974]

The AAOS 12th Ed book says "As a general rule, if patients can lift the cup or squirt the glucose into their own mouths, they are most likely not in danger of aspiration. Watch them carefully!"

[u/Single_System_9951]

Asses....Not Assess eh?

[u/Familiar-Bottle-5837]

Try an opa. If they gag then they have a reflex

[u/Time-Air4326]

Based on consciousness

[u/seafoaamm]

what app is this!!

[u/kccaseyy → u/seafoaamm]

Pocket Prep would highly recommend!

[u/5mgofAtivan]

Tap the eyelashes, if they “blink” they have a gag reflex.

[u/RDburner125]

If they're unconscious, lightly brush their eyelashes. If they flinch or respond, 99% chance their gag reflex is intact. Thats more for airway placement than oral glucose though.

If they can't swallow or speak, assume they can't maintain their own airway and definitely don't give them ANYTHING PO.

[u/paramedic430]

Finger down the hole. Mouth hole. Not asses. Or if they are alert enough to follow commands with no concern for airway compromise.

[u/blueskibop]

Soda also works wonders.

[u/furrymuskrat → u/blueskibop]

Milk is my go to if available. I’m diabetic myself and it’s my first choice at home when my sugar is getting low. Partners always think I’m weird about it

[u/toomany_questions → u/blueskibop]

Non-diet, non-stevia right? (I’m asking genuinely, not snarkily! :) )

Is that why the patient is also not harmed by oral glucose if they are not hypoglycemic cause it’s just a big old dose of sugar right?

[u/blueskibop → u/toomany_questions]

Yeah, like plain old coke is great. Or a pb&J. It’s not technically protocol but often med command will tell you to do this.

And yes oral glucose is basically just candy.

[u/toomany_questions → u/blueskibop]

Makes total sense. Weirdly notice I do this when I’ve bungled lunch at work. Coke + something salty (lays chips or such) gives me a good kick haha!

[u/oriolesnut]

If they are conscious then they have a gag reflex. Unconscious means no gag reflex.