Vancouver IM LMR

Much thanks to Deborah Hendy MSc, RSLP, SLP for taking the time to give a great noon rounds presentation on swallow dysfunction! This is a very relevant topic to all staff and learners on acute medical wards.

See the didactic slide deck here.

Key takeaways:

• When to refer to SLP?
  • Patient self-reports symptoms of dysphagia
  • Coughing/ choking with inhale
  • Voice changing after swallow (sounding “wet”)
  • Complaining of foot stuck in throat
  • Patient reporting effortful swallow
  • Concerns regarding respiratory status related to potential aspiration
  • Prior to G-tube insertion
• Swallow assessments:
  • Adult swallow screen: series of questions + water test
  • Bedside clinical swallowing assessments: includes thorough chart review, collateral, history, oral mechanism exam (OME), and food + fluid trials
  • Instrumental swallowing assessment:
    • When to consider:
      • Previous silent aspiration, multiple admissions with potential aspiration PNA, spinal cord injury patients
      • If bedside assessments are equivocal
      • To inform treatment or goals of care
    • Types:
      • MBS: modified barium swallow (also called VFSS i.e. videofluoroscopic swallowing study) is an X-ray video
      • FEES: fibreoptic endoscopic evaluation of swallowing is a live, colour video
• Other key points:
  • G-tube use does NOT consistently result in reductions in aspiration (can still aspiration oral secretions and/ or gastric contents)
  • Reconsider PO feeds in someone on HFNC who requires high FiO2 or high flow rate, has a high RR, or cannot manage their own secretions
  • Thickened fluids is NOT always better! Aspiration of thickened liquids proves a larger risk than thinner fluids and there is reduced ability to clear thickened fluids from lungs