asked 2 months ago
Pt was involved in an MVC, trapped, possible head injury, GCS 4, pt went VSA post extrication. When OPA attempted there was a loud gag, we have never seen this. Was this a gag reflex or something else?
1 Answers
answered 1 month ago
As you rightly pointed out, a GCS of 4 signifies severe neurological compromise, and a genuine gag reflex is typically absent at this level of consciousness. What you observed in this clinical scenario is more likely a brainstem reflex rather than a true protective gag reflex. Brainstem reflexes can persist even with severe brain injury when “higher” functions are compromised. Furthermore, you may have experienced “agonal respirations” or “gasping,” which can mimic the gagging sounds in the VSA scenario. As a side note, this can often be distressing to the family and requires explanation when they observe what appears to be breathing or signs of life.
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