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?
In: 1727
People are giving far more details in the comments so I’ll just offer what I can.
My dad was the only general surgeon in the county in all three towns’ we’ve lived in. Naturally he was on call for the ER all the time. We’d be having dinner, his phone rings, well.. He’s gotta go. Y’know? I don’t see him for a good chunk of my early childhood but the other option is quite a few dead people.
When I was an idiot kid ( and not* the idiot adult I am today ) I asked him how he dealt with the dead and dying.
As usual he got real quiet, did that ‘thinkin’ look some dads have. Then said something along the lines of ‘I just deal with it. One step at a time.’
He’s been covered in all manner of bodily fluids. A time or two >! infections on patients would balloon up and would need surgical intervention to prevent injury or a big biohazard issue in a patients room. I only heard two stories about it but he’s been basically ‘shotgunned’ by pus a few times. !<. He also told me about >! a few times a surgeon nicked an artery and they’d pull him (my dad) in to help close it off. It’s how I learned how quick people can die, even in a highly professional surgical setting. !<.
I know that had nothing to do with the question but I hope it was a fun read
It’s a risk thing. It’s a known risk that you can aspirate under general anaesthetic (food into lungs). Once the endotracheal tube is in, the risk to lungs is vastly reduced. But it can only go in after being put under, so there is a period where the risk to airway is higher. So if elective surgery is needed, you get them to fast before.
In emergency surgery, the risk of not doing the surgery vastly outweighs the risk of aspiration. You can put a tube down into the stomach and suck up what you can from the stomach but you’ll only get liquids.
It’s basically a balancing act
Just wanted to add that after an emergency surgery the nurses are on super high alert for any signs of aspiration pneumonia. The moment my husband developed a cough, they started collecting sputum and drew what looked like 27 different containers of blood.
ED nurse here.
Trauma surgery implies a patient that has been injured severely enough that requires immediate surgery. Measure are of course out in place to reduce risk for aspiration, but understand that trauma surgeries are time critical, so you need to prioritize the surgery. The benefits outweigh the risk (live patient with vomit in your lungs>dead patient with no vomit in your lungs). This is not to say that aspiration risk isn’t important, rather that it doesn’t matter if you are 1 hour ago. You will likely die without the surgery.
Also, when an advanced airway is placed, ie. ET tube, your airway is protected to see degree. Anything above the cuff can and should be suctioned.
They don’t. Anesthesiologists do.
The drugs given and methods for intubation are chosen based on an entire clinical picture, taking into account all the conditions a patient may have in order to minimize risk to the patient. If we can wait, we wait. If we can’t, we adjust accordingly.
source: Level 1 trauma anesthesiologist
ELI5: Missed tips and some myths and misconceptions in many good previous answers.
(1) For elective surgery in healthy patient without previous upper abdomen/digestive tract surgeries is recommended to fast after light meal for 6 hours, and for 2 hours after clear carbonated fluids.
But this will not prevent vomiting and will not 100% guarantee no stomach content 😕. The only reason to fast is hopefully to reduce stomach content volume and content acidity and to lower risk of clinically significant aspiration.
Vomiting is active ejection of stomach content because of contraction of abdomen, chest and diaphragm muscles. The only way to avoid vomiting is to fully paralyze the patient.
Even then paralyzed patient can regurgitate (stomach content returns to mouth). Suction tube should be handy.
And aspirate (mouth content enters lungs).
Tracheal tube cuff does not prevent aspiration (ask your ICU colleagues).
When there’s a patient out of category (1), recommendations for fasting are less relevant because they are approved for healthy patients and elective surgeries only.
When there’s a crashing patient, he most probably will have more chances to survive when damage control done in short time even in the case of aspiration during airway management.
And here’s some [fun technic of airway management during regurgitation](https://youtu.be/Jaq-vHbcGi0)
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