# Absent gag reflex



## daedalus (Aug 20, 2008)

We are all taught not to place a Oral Airway into a patient with an intact gag reflex, although is an absent gag reflex not a sign of serious cranial nerve issues or brain death at the stem?


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## mycrofft (Aug 20, 2008)

*The two are not mutually exclusive*

Truly absent gag "reflex" means something affected the sensory pathway from oropharynx to brain and back, but airway embarassment is airway embarassment, and the air still has to go in and out (and any vomiting you cause, just out). Other considerations besides mechanical insult or CVA are chemicals, hx of surgery to those nerves, cancer, idiosyncratic condition,etc., but mostly very bad things in the lower brainbox like flatline, in my limited experience. Be ready with plan B (clearing airway) and C (assisted vent). Good info for the receiving hospital.


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## Ridryder911 (Aug 20, 2008)

Not sure what the question is. One can have an absent "gag" reflex without cranial damage. Deep unresponsiveness can produce such, even severe brain damage patients may still have intact primal reflexes such as the gag, biting, snowling. 

Even though they may still have a "gag" reflex one can still place a nasopharyngeal airway and positioning to help reduce airway obstructions. Which I see many fail to perform. 

I am proud to say we use quite a few Nasal trumpets a week, where I work at. It is not unusual for me to place two NP's in patients with difficult airway. Something I was always reminding fellow medics when I received them in the ED, without an airway in place. Their excuse being that they had a "gag" reflex. Even more so in regards to nasal intubation can be attempted with such reflexes. 

Many fail to even place (non traumatized) patient in a head tilt position using towel, pillow under the shoulders.


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## Aileana (Aug 20, 2008)

Absent gag reflex isn't necessarily due to brain trauma. A medic I have trained with a lot has no gag reflex, so I got to learn how to place OPA's on him while he was conscious (and get feedback on it as well ).


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## mikie (Aug 20, 2008)

Aileana said:


> Absent gag reflex isn't necessarily due to brain trauma. A medic I have trained with a lot has no gag reflex, so I got to learn how to place OPA's on him while he was conscious (and get feedback on it as well ).



that's kinda awkward, but makes sense as for feedback, just not a common practice.  

i could probably pull that off, just never had the opportunity to try?


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## Aileana (Aug 20, 2008)

Yeah, I have to admit, it's a bit unnerving to have your 'patient' watching you as you place it, and then give you feedback as soon as it comes out 
'Tis a great training resource though, I'm a lot more comfortable placing OPAs now


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