24. Unexpected Regurgitation

24. Unexpected Regurgitation

It has already been stated that the grossly obese are more likely to regurgitate, and that these Patients are considered unsuitable candidates for a Tulip.

The Tulip is contraindicated in non-fasted Patients and those at risk of aspiration, such as the grossly obese, those with hiatus hernia, previous opiate analgesia, those with a recent traumatic injury, massive or multiple injury, those of greater than 14 weeks gestation, those with an autonomic neuropathy and those with an acute abdomen, reduced gastric emptying or dilation of the stomach.

The likelyhood of aspiration may be minimized by using a combination of H2 antagonists, antacids and drugs to increase gastric emptying and to reduce both the acidity and the volume of the gastric contents. Patients with hiatus hernia, opiate analgesia, recent traumatic injury and those with autonomic neuropathy are all more likely to retain gastric contents despite an adequate starvation period.Watch movie online The Transporter Refueled (2015)

The use of a nasogastric tube is not usually recommended with a Tulip, as the presence of the nasogastric tube may induce oesophageal sphincter incompetence and may allow the leakage of gas around the oropharyngeal seal that has been established by the Tulip’s cuff.
Once regurgitation has been suspected, the Patient should be placed in the head down position in an attempt to visualize regurgitant fluid. The fluid should be subject to a litmus test to confirm its acidic nature prior to instigation of steroids and antibiotic therapy. Such a finding may be supported by using careful fibreoptic laryngoscopy.

It is recommended that plans to intubate the Patient with an Endotracheal tube are instigated if the Patient is stable and well oxygenated.