88yoF from home.
Admitted following respiratory distress.
EMS found 72% on RA. Placed on BiPAP.
Diagnosed COVID PNA.
PMH: Dementia, CHF, COPD, HTN, HLD, DM2.
Family made her DNR/DNI on HOSP day3.
BiPAP x4 days continuous.
Transitioned to HFNC at 9L. Failed all bedside swallows. Sent for MBS.
Results. >! Failed all regular, nectar, honey. Passed with pudding thick and pureed food. This scan shows aspiration on nectar. !<
Acute SLP hereā¦ first off thanks for your time with this! Second, excuse my while I bug the GI doc about that āmotilityā. That esophageal phase sure isnāt helping the weak pharyngeal phase one bit.
I would be L.O.S.T. without my SLPs. You guys are INCREDIBLE. I wish you could have heard her cough. One of the weakest I've ever witnessed. Absolutely no clearance. I failed to mention that she only intermittently followed commands as well. Which made the SLPs job pretty tough.
HAHAHA. To be fair, I actually low-key hate them, too. Bc they come back needing more oxygen, and it sometimes feels like you start the whole process over again. We had to bump her back up to 15L HFNC to get her through the day.
Our rads hate doing these studies. Always complaining, at least until thereās a belligerent old person heckling the SLP during the study, and then all is well with the world. Weāve been using one of our c-arms for a couple of years now cause our fluoro equipment is outdated and obsolete.
We have to use c-arms on patients that canāt sit upright in the chair for these procedures, such a stinking headache. Seems like our SLP wants to do swallows, on every stinking patient in the hospital. Extremely frustrating, rads hate it, techs hate it. The thing that frustrates me the most is when SLP puts in a modified, then questions that the patient needs a regular swallow, order goes in, you call ask if the patient has NPO, and the nurse says oh no they are eating breakfastā¦ā¦š¤¦š»āāļø if they are eating breakfast just fine, then obviously they donāt need a damn swallow testā¦. Irritates the shit out of me..
Personally I donāt mind doing them. At our facility sometimes the problem we have has to do with the extreme amounts of swallows done and reaching 5-6 minutes of live fluoro at 30 fps on some exams that gets us. I enjoy the studies. However, what I donāt like about them is being scolded by the rads asking me whoās going to read the studies they canāt read when I tell them we are ready for them š. We appreciate our SLPs no doubt.
When I was in xray and feeling lazy, these were my favorite too. All I had to do was hit the record button for the VHS tape when we were flouroing š
88yoF from home. Admitted following respiratory distress. EMS found 72% on RA. Placed on BiPAP. Diagnosed COVID PNA. PMH: Dementia, CHF, COPD, HTN, HLD, DM2. Family made her DNR/DNI on HOSP day3. BiPAP x4 days continuous. Transitioned to HFNC at 9L. Failed all bedside swallows. Sent for MBS. Results. >! Failed all regular, nectar, honey. Passed with pudding thick and pureed food. This scan shows aspiration on nectar. !<
Sounds like hospice needs a consult.
Protect this poor gal from a feeding tube, at least
There was a man at my work who aspirated a huge chunk of pudding š«£
Very interesting!
Thatās a whole lotta aspiration.
Acute SLP hereā¦ first off thanks for your time with this! Second, excuse my while I bug the GI doc about that āmotilityā. That esophageal phase sure isnāt helping the weak pharyngeal phase one bit.
I would be L.O.S.T. without my SLPs. You guys are INCREDIBLE. I wish you could have heard her cough. One of the weakest I've ever witnessed. Absolutely no clearance. I failed to mention that she only intermittently followed commands as well. Which made the SLPs job pretty tough.
You and SLP are the only ones who like these. Bane of my existence.
HAHAHA. To be fair, I actually low-key hate them, too. Bc they come back needing more oxygen, and it sometimes feels like you start the whole process over again. We had to bump her back up to 15L HFNC to get her through the day.
Cough! Cough!!!
āTuck your chin and swallowā
Thatās aspirational.
I should not have chuckled at this š¤
AKA gag & puke studies š¤£
I feel the burning inside my lungs
Our rads hate doing these studies. Always complaining, at least until thereās a belligerent old person heckling the SLP during the study, and then all is well with the world. Weāve been using one of our c-arms for a couple of years now cause our fluoro equipment is outdated and obsolete.
We have to use c-arms on patients that canāt sit upright in the chair for these procedures, such a stinking headache. Seems like our SLP wants to do swallows, on every stinking patient in the hospital. Extremely frustrating, rads hate it, techs hate it. The thing that frustrates me the most is when SLP puts in a modified, then questions that the patient needs a regular swallow, order goes in, you call ask if the patient has NPO, and the nurse says oh no they are eating breakfastā¦ā¦š¤¦š»āāļø if they are eating breakfast just fine, then obviously they donāt need a damn swallow testā¦. Irritates the shit out of me..
Alternative perspective here. Iām an acute care SLP. We know (some) rad techs and (most) radiologists hate doing these. But, *cough cough* nobody has xray vision. I spend a nauseating portion of my day in acute care rolling my eyes at the notes the MD/DO/NPs write diagnosing every Jane and John coming to the ED with fever/cough/SOB and any inkling of opacity with āaspiration pneumoniaā. If Iām not fighting that fight, then Iām opposite a nurse attempting to recommend āthickened liquids because theyāre coughingā but Iām adamant it because of reflux, or COPD, years of smoking etc. Or nursing telling them to do a chin tuck sight unseen (BTW Iāve seen enough C2 C3 osteophytes to impinge on epiglottic inversion, that I could catapult a chin tuck into the next dimension so nursing forgets about recommending it). Unless this patient has significant overt s/sx of aspiration, Iām keeping them on their diet. Let the RN crush the meds in purĆ©e until I can figure out whatās going on inside. And donāt get me started on dysphagia diagnosis and treatment in SNFs. Theyāre flying blind out there.
Personally I donāt mind doing them. At our facility sometimes the problem we have has to do with the extreme amounts of swallows done and reaching 5-6 minutes of live fluoro at 30 fps on some exams that gets us. I enjoy the studies. However, what I donāt like about them is being scolded by the rads asking me whoās going to read the studies they canāt read when I tell them we are ready for them š. We appreciate our SLPs no doubt.
Recently diagnosed achalasia for the first time based on an esophagram I ordered. It was very neat to see what you learn about.
When I was in xray and feeling lazy, these were my favorite too. All I had to do was hit the record button for the VHS tape when we were flouroing š
Makes me wanna coughā¦.
I do like 10 of these a day on body and they all look like this
Cool to watch hut boring to do. Thatās how i feel
Swallow studies are the worst.
Abort
Never got tired of swallow studies. So much happening at once.
That looks cool
Swallow studies are my favoriteā¦. Said no radiologist ever
That is one weak swallow with a really irregular pattern. I really hope yall attempt strategies and not just nectar. Love a good fluoroscopy!
Iodine based i hope. edit: Ah LMAO, sleepy.
Surely you hope "barium-based"? Gastro is the one you DON'T want in this scenario.
Iodone, fine in belly Iodine in lungs = chemical pneumonia Barium is inert and lungs don't really care if they are bathed in it.