How do trauma surgeons deal with the fact that the patients they operate on probably haven’t fasted the night before given that trauma patients don’t know in advance they’ll be having surgery?


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

This is more related to anesthesia than surgery

Anyway, there is a method called rapid sequence intubation where anesthesiologists will give fast acting medication to put the patient under and put the breathing tube in. Usually~~ you give patients oxygen before attempting to put in the breathing tube, but here they forgo that since it adds more time they could potentially vomit.~~ They also position the patient with the head higher up to avoid effects of gravity or their belly on their stomach. Once the tube is in the trachea, there is an inflatable cuff around it that seals the wind pipe so if the patient did vomit it wont go into the lungs.

Its still a risky procedure, so typically only done during life or death cases.

There are some of the anesthesia drugs, like propofol, that have antiemetic effect but really trauma surgery is all about risk/benefit. If immediate surgery is required to save life or limb, then the risk of aspiration is worth taking. Also many emergency procedures now, like say appendectomy, can be done using a spinal and so the risk of aspiration goes way down without intubation. Also, in general, the science has changed on preoperative fasting, and unless you are having major bowel surgery, you can down have clear fluids up to a few hours before a lot of procedures. It has been recognized that the negative impacts of fasting on blood sugar (especially for diabetics), body temp regulation, and post op recovery is often greater than the risk of aspiration. Source – am RN.


It’s an emergency, so you do your best under the circumstances and deal with complications as they come.

In the case of anesthesia, they’re worried about the possibility of the drug making the patient vomit, or worse, vomit just a bit and then inhale it back into the lungs. If you plan the surgery, you can plan on the person having an empty stomach, but in the emergency room you assume it’s full, hope for the best, and be prepared for the worst.

One thing they can do is run a tube down the airway to keep it open and free from contents from the stomach. There’s an entire procedure for doing this quickly before the surgical procedure begins.

But it’s still emergency medicine: hope for the best, prepare for the worst, prioritize in order of criticality.

I had an emergency appendectomy and while I hadn’t eaten anything for the previous day due to severe pain, They ended up needing to do a CT to diagnose because I wasn’t presenting the textbook case for appendicitis. Ct scan I had to drink a giant tub of contrast agent, and when I came out of anesthesia I managed to throw it all up and inhale it into my lungs. Since it was general I only have vague memories of this but there was a lot of being encouraged to cough and the next day.everyone on the surgical team came to look at my mouth which I believe was scraped up from them vacuuming contrast agent out of my lungs. So that’s exactly why they asked that your stomach be empty. I don’t have any medical background but doctor internet says that I probably had a one in five chance of dying from aspiration of my stomach contents.