Vomiting While Using I-Gel

hatty444

I have recently been trained in using an I-Gel in a CFR - Advanced course. I have been thinking and am wondering what the best course of action is if a Patient vomits while the I-Gel is inserted. I know the when someone vomits during CPR its from air seeping into the stomach when breaths are being delivered. I know there is a Gastric Channel in the I-Gel but does that prevent vomiting. There have been some articles that state that suctioning can be done from the gastric channel but what id some undigested food enters the gastric channel and it becomes blocked. Do I remove the I-Gel and continue on with normal breaths with a BVM or do I just leave it in as it does not effect the Airway as the I-Gel covers the entrance of the trachea.

Thank you in advance for your response.

Dean

iceage

Tough one there. If it's a gag reflex my instructor said remove the Igel, ie the patient isn't truly unconscious and revert back to your BVM. If the patient vomits and is unconscious my gut instinct would be to remove the I gel, suction to clear and then maintain a patent airway. Question is really do you re-insert the I gel.. Again my guys said work your way back up the ladder, I Gel, OPA, BVM. As long as they have a patent airway and you can maintain it and manage to get air into them, its working isn't it.

hatty444

You see the gastric channel prevents vomiting. You can also suction through the channel, but do you think its possible to continue using the I Gel and suction or should you remove it. It is something that may never be relavent being in a Voluntary Organisation but it is just something that I thought about.

civdef

Was this not covered on your CFR-A course?

EGOSHEA

(Just doing an EMT training at the moment and took the DFR-A the other day)

If there's vomit in the iGel, you wouldn't really want to be placing that back in (you'll hardly be taking the time to clean it if the situation warranted the device in the first place). I reckon you'd switch to a Guedel or revert to a BVM. Just my two cents.

glenjamin

If they vomit then just quickly remove the I-gel, suction, and use a BVM instead. There's no point in cleaning off the I-gel or using a new one, having to lube it up and insert it when you're basically gonna be wasting time. And then if you were to reinsert it again the patient could end up gagging once again. They could be P on the AVPU rather than U if they're gagging.

GoProGaming

glenjamin wrote: »

They could be P on the AVPU rather than U if they're gagging.

But then you wouldn't be using an igel in the first place.

EGOSHEA

GoProGaming wrote: »

But then you wouldn't be using an igel in the first place.

Might start to use it in 'good faith' (i.e. with an apparently/at that time unresponsive patient) only to have them come to with what must feel like a doll's arm down their throat!

GoProGaming

EGOSHEA wrote: »

Might start to use it in 'good faith' (i.e. with an apparently/at that time unresponsive patient) only to have them come to with what must feel like a doll's arm down their throat!

personally i wont be putting an igel or king lt airway in anyone who had a pulse but each to their own.

You cant beat basic airway management in your average pt.

glenjamin

GoProGaming wrote: »

But then you wouldn't be using an igel in the first place.

They could have started at U and gradually become P.

sjb25

glenjamin wrote: »

They could have started at U and gradually become P.

But as an EMT you should only be using advanced airway in a case of adult cardiac arrest so they will be U not could have been they will......obviously if you get to the point you get them back and the are tolerating leave it be and if they gag or vomit wip it out suction and do whatever necessary and obviously if you are in that great postion that they are responding you will not need to reinsert

MN_Medic

If you are able to ventilate using and OPA then there is no reason why you would change to an advanced airway unless you're transporting and need to secure the airway. Even then if your basic airway management is working carful consideration should be applied to changing it. If it isn't broke don't fix it!
If you have an iGel in situe and the stomach contents begin to come up start suctioning with a soft catheter through the port on the iGel. If that doesn't work and the airway is occluded or at risk of being occluded, remove the airway, suction and revert back to basic airway management. I would not attempt to reinsert the iGel after that.