Please be specific when documenting trouble at mealtimes. Technically, choking is about not being able to breathe because something is obstructing the airway, but the term “choking” is often confused with “coughing”. It takes air to cough, so if you’re coughing, you’re breathing. Truth: Related to the one above, coughing is protective. But as above, you need to actually see what’s happening to know for sure. It can also be from another medical condition and completely unrelated to eating. A cough can be a sign of aspiration, but it can also be the way a person protects themselves from aspiration. A strong cough is a good sign you’re actually not getting food caught in your lungs. Truth: A cough is a protective reflex meant to expel things from the airway. Nobody has x-ray vision.Ģ) Myth: If you cough, you’re aspirating. The only way to tell if someone is taking food or liquid into their lungs is to see it on an instrumental swallowing assessment (MBS/VFSS or FEES). Truth: It’s called silent aspiration for a reason. Many physicians will order a confirmatory test for brain death when the clinical examination demonstrates no neurological function.1) Myth: If you don’t cough, you aren’t aspirating. In some brain dead patients, when the hand or foot is touched in a particular manner, the touch will elicit a short reflex movement. If, after this extensive clinical examination, the patient shows no sign of neurological function and the cause of the injury is known, the patient can be pronounced "brain dead." In some states, more than one physician is required to make this pronouncement in order for brain death to become legal death.Īlthough the patient has a dead brain and dead brain stem, there may be spinal cord reflexes that can be elicited (a knee jerk, for example). When the CO2 level reaches a level of 55 mm Hg, the active brain will cause the patient to breathe spontaneously. With the cessation of breathing by the machine, the body will immediately start to build up metabolic waste of carton dioxide (CO2) in the blood. The patient is temporarily removed from life support (the ventilator). The patient has no spontaneous respiration.The movement of the breathing tube (in and out) or the insertion of a smaller tube down the breathing tube will cause a gag reflex in a comatose patient, but will not elicit a reflex in the brain-dead patient. The drastic change in ear temperature will cause a violent eye twitching by the intact brain but no reaction in the brain-dead patient. While holding the eyes open, ice water is injected into the ear canal. The patient's ear canal is inspected to ensure an intact tympanic membrane and that the ear is free of wax. The patient has no oculovestibular reflex.The resulting stimulation pressure will cause motion of the extremities, either purposeful or primitive posturing, in the living-brain patient, but none in the brain-dead patient. The patient's eyebrow ridge is compressed with the thumb. The patient has no response - either purposeful or posturing - to supra-orbital stimulation.The intact brain will want the eye to blink. ![]() A cotton swab is dragged across the cornea while the eye is held open. The active brain will allow a roving motion of the eyes the non-functional brain will not. The patient's eyes are opened and the head turned from side to side.
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