Gag reflex

Nasogastric or orogastric Short-term Intact gag reflex Normal gastric emptying Manually at bedside Ease of placement Allows for all methods of administration Inexpensive Multiple commercially available tubes and sizes Potential tube displacement Potential increased aspiration risk... 

Gastroparesis/atony causing regurgitation Feeding tube malpositioned Compromised lower esophageal sphincter Diminished gag reflex... 

Phosgene is very poisonous so insidious that it was used as a war gas in World War 1. One deep breath can cause immediate collapse and death, and as it is not irritating there is no gag reflex to prevent one from taking that deep breath. Doses which are not high enough to be immediately lethal may not be noticed at till at the time of exposure, yet lead to death within 24 hours. Sub-lethal doses cause pulmonary edema and serious respiratory disability again, the symptoms can appear well after an exposure which was hardly noticed. 

Limited solubility or suspendability of a material often dictates preparation of dilute mixtures that may require large volumes to be administered. The total volume of liquid dosing solution or suspension that can be administered to a rodent is limited by the size of its stomach. However, because rats lack a gagging reflex and have no emetic mechanism, any material administered will be retained. Guidelines for maximum amounts to be administered are given in Table 13.5. 

Because clove cigarettes also contain tobacco, they carry all of the hazards of regular tobacco smoking (Council on Scientific Affairs 1988). Several cases of serious medical illness have been associated with clove cigarettes in the United States (Guidotti et al. 1989). These include cases of hemorrhagic pulmonary edema, pneumonia, bronchitis, and hemoptysis. Because eugenol anesthetizes the respiratory tract, it inhibits the normal gag reflex and has led to aspiration pneumonia in at least one case. Accidental overdoses in children have led to CNS depression, urinary abnormalities, and anion-gap acidosis. These cases were treated successfully with supportive measures (Lane et al. 1991). 

Regurgitatlon/Aspiratlon Observe unconscious or semiconscious patients with impaired gag reflex and those who are otherwise prone to regurgitation or aspiration during use, especially if given via a nasogastric tube. If Gl obstruction or perforation is suspected, rule out these contraindications before administration. 

Benzocaine Street Names Coco snow, flat chucks and potato chips (crack cut w/ benzocaine) Use Cutting agent for crack (increases bulk of product and gives a numbing effect like cocaine) topical OTC anesthetic (brands many OTC topical forms) Actions Topical anesthetic used in many OTC products Effects Methemoglobinemia from excess topical or oral use. Over application of topical oral agents can impair gag reflex... 

Supportive care is important, especially in unconscious patients. If the airway is protected (gag reflex or cuffed endotracheal tube present), then activated charcoal can be given. Repeated doses of oral activated charcoal increase the rate of elimination of several tricyclic antidepressants, but may not influence outcome. 

Contraindications Ingestion of petroleum distillate, ingestion of strong acids or bases, ingestion of strychnine, unconsciousness or absence of gag reflex, hypersensitivity to ipecac or any component of the formulation... 

Some people experience hyperthermia, a warming of the body. Nausea Is rare, though by the eighth swallow of the leaves the gag reflex becomes overwhelming. Still, except for the swallowing part, almost nobody gets sick at the stomach. 

There are a variety of other physical symptoms that occur upon ingestion of A divinorum. Hyperthermia occurs with some subjects (8), and this researcher has spoken to others who experience diaphoresis and chills. According to Wasson, the Mazatec Indians often vomit when they ingest the leaves of Ska Pastora (15), but others report that nausea is very rare and that it is simply the act of swallowing the leaf material that stimulates the gag reflex (8). 

The Indians generally fast before using peyote to diminish the potential for nausea consumption of food and especially alcohol prior to peyote ingestion greatly increases the chances of vomiting. Sometimes the gag reflex is triggered purposely, as when they are trying a cure. 

Many ingenious techniques have been used to make peyote and San Pedro more palatable—to facilitate absorption of the psychoactive molecules without triggering the gag reflex. In most Native American Church rituals, the peyotists simply put a dried button in the mouth until it is soft enough to be chewed and swallowed. That takes some time. They pass around milk and may smoke. When peyote is ingested in this fashion, its cactus soapy, bitter taste is soon displaced substantially by a numbness. 

Gag and cough reflexes can be suppressed by neuroleptic drugs (SED-11, 107). Periodic examination of the gag reflex, particularly in patients with tardive dyskinesia, has been recommended. 

Irrtact gag reflex Allows for all methods of administration Potential Increased aspiration risk... 

Botulism-like Acute paralytic conditions consistent with botulism such as cranial nerve palsy, ptosis, decreased gag reflex Acute descending motor paralysis Acute symptoms consistent with botulism such as diplopia, dysphagia Botulism... 

Loss of the gag reflex and dysphagia may require intubation and mechanical ventilation. Deep tendon reflexes are often lost during later stages of intoxication, and death in untreated patients results from airway obsfruction or inadequate tidal volume (Amon et al, 2001). Respiratory failure is the most serious clinical manifestation of botuhsm. 

Of the 58 patients in the study (316), 34 were considered to have normal gag reflexes, nine to have variable responses to touching the posterior pharngeal wall, and 15 to have definitely Impaired gag reflexes. The last two groups were combined for the analysis of drug use. All 58 patients had been receiving neuroleptics and antlparklnsonlsm drugs 12... 

---