[Dysphagia] reposting aspiration of emesis as listserve member

[gjackson at rochester.rr.com (gerriann jackson)]

 Does anyone have guidelines or suggestions for a swallow evaluation post
> NPO status? Do you do an eval with a small amount of food, so as not to
> induce vomiting?  I had a patient this week who had been NPO for two days,
> had previously been malnourished secondary to poverty.  He was trialed
with
> a lunch tray and did quite well with the mech soft consistency of the
> meatloaf that was served, so I allowed hime to eat the portion while I
> monitored.  I was glad that I had done it, as I was able to see that he
was
> quite impulsive and place him on appropriate supervision to monitor
pacing.
> Later that day when nsg staff had him fully supine to do cares, he had an
> episode of emesis and aspirated.  He is now on bipap.
>
> The gentlemen is a retired farmer who had a CVA 1 year ago, never went to
a
> doctor and presented to our hospital which cellulitis of both legs.  He
only
> came in because he could not walk.  He was very congested on admission and
> was receiving O2 via nasal cannulla and breathing treatments prior to
> evaluation.  We were asked to eval because he coughed with med passes.  He
> was initially NPO awaiting swallow eval, but nsg in ICU reported to us
that
> he was NPO due to unstable vitals and sent us away.  We documented both
> attempts and the hospitalist finally read the chart and hunted us down to
> tell us pt. was only NPO for our eval.  During our eval we noticed
> neurological signs(mild-mod right sided weakness of lip, tongue and upper
> extremety along with a sig. dysarthra) asked the pt. about them and he
> reported that he thought he had had a stroke about a year prior.
Subsequent
> CT scan proved him correct.  So, while he handled the consistencies that
the
> bedside eval suggested would be appropriate, I am concerned that he
vomited
> because he hadn't eaten in so long prior to eating a full portion of
> meatloaf and mashed pos.  I have no way to confirm this, but I wondered if
> there some standard precautions that were typically taken when a patient
has
> been NPO for a while so as not to induce a reaction like reflux or
vomiting?
>
> Thank you,
> Gerriann Jackson