Dysphagia

Question 1

Walk me through a bedside swallow eval

Answer 1

90 degrees

get a good history

perform OME

offer textures

Question 2

consistency of trials

Answer 2

thin & thick liquids

pureed

wet soft (fruit cocktail)

dry soft (bread)

dry-crumbly (cracker)

meat

Question 3

What are you looking for in a bedside swallow

Answer 3

Red flags

Question 4

Medical red flags

Answer 4

dx

s/s

weight loss/ nutritional status

respiratory states

cognitive issues

being fed by caregiver??!!

age/frality

Question 5

oral red flags

Answer 5

leakage of material out of mouth

pocketing of material in oral cavity

drooling

labial/lingual weakness

sneezing

runny nose

spitting out of food

difficulty taking material from utensil

Question 6

pharyngeal red flags

Answer 6

coughing

throat learning

wet/gurgly voice quality

drop in O2 sats (below 90)

sticking material

multiple swallows to clear

Question 7

esophageal red flags

Answer 7

globus

belching

heartburn

acid taste

material moving swallow

coughing after eating/drinking

coughing at night/while lying down

Question 8

What to conclude after bedside eval

Answer 8

swallow tx

diet change

MBS/VFSE

FEES

further esophageal assessment

Question 9

gold standard for dysphagia eval

Answer 9

MBSS

Question 10

Blue dye test

Answer 10

trach patients

OME

DEFLATE THE CUFF and have nurse suction

use finger occlusion or pass-muir valve to voice (“ahhh”)

if voicing yes then continue. If not, end eval

add blue dye for all textures

after each texture, suction immediately after each trial, 10 minutes after the last one, 20-30 min after the last one and the nurse or RT suction throughout the day

only 40-50% accurate

Question 11

positioning for treatment of dysphagia

Answer 11

head turns

head tilt

recline (tongue is gone)

list to left or right (moving the trunk)

have them try these positions during the MBS so it can be recommended

Question 12

strategies for treatment for dysphagia (while eating)

Answer 12

small bites/sips

chin tuck

hard/effortful swallow

repeat/extra swallows

alternate solids with liquids

throat clears

super supra-glottic swallow

Question 13

equipment strategies

Answer 13

nosey cup

bionic reusable safe straw

small teaspoons or toddler spoons

Question 14

swallow strategies

Answer 14

sit upright 90 degrees

small bites/sips

chin tuck

hard effortful

repeat extra swallows w/ head turned to the left

alternate solids with liquids

periodic throat clears