NPO guidelines for breast milk??
Started by Mikkel
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We have 3h.
How do you have a patient that drinks breast milk but knows npo guidlines 🤔
How do you have a patient that drinks breast milk but knows npo guidlines 🤔
D
deleted162650
Yes 4hrs for breastmilk is the guideline. I woulda cancelled just ‘cuz the guy was too weird though. I don’t think the guidelines were meant to apply to adults.
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An adult drinking breast milk would get 8 hours and a psych consult while he was waiting.
I would tell them that’s an accommodation we make for infants who can’t tolerate hunger pain and/or hypoglycemia, not for adults.
I would tell them that’s an accommodation we make for infants who can’t tolerate hunger pain and/or hypoglycemia, not for adults.
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deleted162650
I think we may have stumbled upon the etiology of his stomach issues.
Wait....did he drink from the bottle or "from the source" because maybe he doesn't really need that psych consult? Just sayin....
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deleted87051
Did he get it on Craigslist?
Was it 100% Cambodian?
WTF?
i think someone is messing with us.
i think someone is messing with us.
Milk coagulates in the stomach on contact with stomach acid, so it’s really a solid...
Human Breast Milk Isn't Safe for Adults to Drink
While a black market for human breast milk is booming, it isn't safe for grown-ups to drink.
www.newsweek.com
Including breast milk?
Do babies process breast milk differently than adults? I always thought breast milk in baby stomach's "pass through" much more quickly compared to formula. Different water content?
I still had the patient wait 2 more hours before procedure. Patient had hiatal hernia and reflux esophagitis.
I didn't ask how he took the milk, but there wasn't anyone with him for me to guess.
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deleted697535
That guy doesn't need an anaesthetic. He's an effing animal
I’m obviously not anesthesia, but when we do nuclear medicine gastric emptying studies for motility disorders, radiotracer in breast milk behaves like a solid, rather than a liquid meal.Human Breast Milk Isn't Safe for Adults to Drink
While a black market for human breast milk is booming, it isn't safe for grown-ups to drink.
Including breast milk?
Do babies process breast milk differently than adults? I always thought breast milk in baby stomach's "pass through" much more quickly compared to formula. Different water content?
I still had the patient wait 2 more hours before procedure. Patient had hiatal hernia and reflux esophagitis.
I didn't ask how he took the milk, but there wasn't anyone with him for me to guess.
I’ve heard that some weightlifters buy and use breast milk.
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Is anyone using point of care ultrasound to assess gastric content in patients with questionable NPO status and/or possible delayed gastric emptying?
Ive read about it. Intriguing but I dont think it has been validated enough to use as a decision making tool at this time
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Gastricultrasound.org is a free web-based educational resource that contains information related to the performance and interpretation of point-of-care perioperative gastric ultrasound for aspiration risk assessment. The information provided is based on peer-reviewed data and the opinion of the...
www.gastricultrasound.org
I had one attending who is all about it and I know it has led him to delay nonemergent cases before
Would he be willing to do non-emergent cases that had eaten but didn't have anything on US?
That, I'm not sure about.
That doesn’t sound wise. If anything were to happen to the patient I would think he would be putting himself at undo medico-legal risk if he didn’t abide by the NPO guidelines for an elective case.
I think it would be a nice move forward if we could have guidlines that would state that it's acceptable to proceed with GA if the stomach is proven empty on US.
Well that's the entire problem with ultrasound (coming from a big believer), you discover things you wouldn't have otherwise discovered. What's the PPV of gastric ultrasonography? If you find something that otherwise wouldn't have made a difference, how valuable is it?
This is a great talk on that topic:
SonoBYTE: Mitral Valve Magic by James Rippey | SMACC Sydney
The appearance of high quality hand held ultrasound machines mean we will all have imaging available at our finger tips. This talk details a personal study on the impact this can have on families. It also outlines the frequency of incidental findings and raises questions regarding the...
smacc.net.au
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What about the flip side? Would you cancel a case that was NPO appropriate if you found food in the stomach? Do you put the ultrasound on the "NPO appropriate" patient who ate a full plate of spaghetti and garlic bread at 2359? What about the semi-elective trauma patient who was NPO appropriate that you were planning an LMA on for the X debridement?
I don't know what the data is, exactly, but I suspect most people's aspiration stories are people who are, or claim to be, NPO appropriate.
I don't know what the data is, exactly, but I suspect most people's aspiration stories are people who are, or claim to be, NPO appropriate.
If it were me I would treat it like any other anesthetic we perform and risk stratify the patient based on what I feel his/her aspiration risk may be. If I took the patient's proper NPO status at face value but found food in their stomach on ultrasound, I would probably just plan for an RSI. The same would go for the trauma patient and I would abort my LMA plan and go straight to an ETT. I'm not sure we should routinely put an ultrasound on a patient who finished a full meal at midnight unless we were concerned about the patient's gastric emptying; e.g. gastroparesis, CP, on a bunch of narcotics, etc.
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deleted875186
Can you give us a brief story of the types of cases he cancelled? I’m hoping it’s something like a patient who has multiple risks factors for a full stomach??
Never happened in my presence, but was just something he talked about. The main sort of situation I think of was the questionable NPO status (yeah I haven't eaten anything since last night, but those crumbs on my shirt the nurse is talking about was from then).
When in doubt, tube.
