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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.