I know that with elective surgeries, patients have to fast the night before to prevent vomiting when they go under anesthetic, but I was wondering how this concern is navigated in trauma or emergency surgeries in which patients definitely didn’t fast the night before? Do they just try to deal with the vomit or is there a special procedure to prevent vomiting from occurring?
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**ELI5 Simple answer:** We give anesthetic drugs and put in a breathing tube very quickly. The tube includes a small balloon at the end which is inflated once the tube is in the windpipe. This balloon creates a barrier that prevents stomach contents (stomach acid etc.) from ending up in the lungs.
We do keep a suction-wand (like at the dentist) on hand if there seems to be vomit or anything else visible.
Not a surgeon or anesthesiologist but a radiologist whose read a lot of Trauma CT chiming in.
It’s INCREDIBLY common for a trauma patient to have a very full stomach. So much so that it can surprise our new trainees who are used to seeing planned outpatient CTs where the patient is encouraged to fast or only take clear liquids. We joke that half our MVCs occur just as the patient pulls out of McDonald’s parking lot
But you’ve got a good answer earlier. The anesthesiologist compensates with rapid sequence intubation. The risk of aspiration is so much less than that of delaying the patient who needs an epidural hematoma decompressed
I had emergency surgery after a heart attack and the solution was only local anesthetic at the incision.
We don’t. Anesthesia deals with it.
Anti emetics, pro peristalsis/motilin agonists, secured airways.
Aspiration isn’t the real risk that’s a priority.
Rapid Sequence Intubation and a whole lot of hope. The biggest risk with vomiting is aspiration pneumonia. But in a trauma surgery situation, that risk is dwarfed by the risk of death. We can treat aspiration PNA. We cannot treat death. It’s all about the risk/benefit analysis. Source – personal experience as an RN in the operating room and endoscopy department (both procedural care with anesthesia)
The whole idea that it is terribly unsafe to be sedated without having fasted for 8 hours is way overblown.
The theoretical concern is that the unconscious patient will vomit or passively regurgitate and aspirate their stomach contents. While this is possible, it is not a common scenario. Good airway management technique prevents complications.
In a true emergency, ER physicians/surgeons/anesthesiologists proceed because they have to.
It’s triage. What will kill you first? Aspiration pneumonia or a ruptured spleen?
The anesthesiologists can perform a “rapid sequence induction” in cases like this where a patient is an aspiration risk but the survey needs to proceed. Essentially, they just induce the patient (put them to sleep) while someone holds cricoid pressure and then they intubate right away without mask ventilation. Once the endotracheal tube is inserted there should theoretically be no risk of aspiration.
I do it at work as a paramedic. You just do it. You prep as best you can. Have suction ready in case they vomit. Position the patient as best you can to have the anatomy lined up and have your tools ready to go so you can get the tube in quickly and also without messing around unnecessarily aggravating their gag reflex.
Once the tube is in you have a cuff that blocks the airway from any other foreign bodies. Sometimes they vomit. You clean it as best you can and we can even do deep sectioning with a flexible tube that goes down the ETT to pull put what we can from their airway.
Usually in trauma surgery, saving someone’s life is prioritized against complications. Also, normally an NG tube is inserted and sucks out stomach contents in sketchy situations while everything is happening.
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