You don’t. It’s emergency surgery, which means it’s:
1. urgently necessary
2. the risk of aspiration is worth taking in the face of alternate outcomes, like death.
They tell you not to eat before surgery to minimize risk. In emergency circumstances that risk is just one you have to take and deal with to try to save a person’s life.
If they’re going to die imminently without immediate surgery, nobody is worried about aspiration.
With planned surgery you just take all of the precautions you can to minimize risk because you can when you’re planning on surgery.
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