Evidence in the EDGag Reflex

Betsy LeePGY 3

Caseo 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?

The Use of GCS in Poisoningo 414 admissions for poisoningo 43 patients admitted

Intubation

No Intubatio

n

Total

GCS ≤ 8 37 18 55

GCS > 8 4 334 338

Total 41 352 393

The Use of GCS in PoisoningIntubatio

nNo

Intubation

Total

Gag Reflex 11 348 359

No Gag Reflex

26 0 26

Unknown 4 4 8

Total 41 352 393

Gag Reflex in Assessing Level of Consciousness

o Examined 38 patients on presentation to the ER that ranged from combative to comatose

o Used a tongue blade to assess for gag reflexo 3 patients lacked a gago 35 patients had a gag – 6 had been intubated PTA,

12 obtundedo 18 ER staff members then assessed

o 4 staff members lacked a gag

Relation between GCS and Gago 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

SummaryAbsence of a gag reflex may be an indicator

that a patient requires intubationHowever, presence of a gag reflex is not a

useful piece of information37% of healthy volunteers do not have a gag

reflex

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

Referenceso 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.