USE THE SWALLOW PROVOCATION TEST TO ASSESS AIRWAY PROTECTION

A patient presents obtunded. You wonder about airway protection and consider intubation. Is there any way at the bedside to gather more information before choosing to intubate?

 

This has not been well studied in the ED population mentioned above, but if you are wondering whether the patient is going to aspirate oropharyngeal liquids, you could consider a safe trial of seeing how they handle liquids.

 

Called the “swallow provocation test” it is done by injecting a “swallowful,” (ie 10 cc) of water into the mouth of the patient.

 

I have had patients leave the secretions there (so I suctioned them out) and proceeded to intubation. I recall one severely alcohol intoxicated patient swish it around in his mouth like he was seeing what it was, then lean over and spit it on the floor (I wondered what he would have done if it were a drink more of his choosing). He did not get intubated, needless to say.

 

While this approach is not validated, neither is your current approach! So consider using this in situations where you are not sure what they need.

 

Take home points:

-If you are wondering how the patient will handle liquids in the mouth, inject water and find out.