My patient keeps biting her tongue!

[europeman]

25yo adenovirus ards on ecmo whenever RaSS anything less than -5 she bites the hell out of her tongue which is really problematic because of the heparin for her ecmo. She's very edematous including her face and tongue. This wasn't a problem when she was intubated but now with tracheostomy her mouth is free to keep me busy! I have tried the Popsicle stick with gauze when that didn't work I put an oral airway in which doesn't work. Her tongue so big and swollen that the airway just doesn't create enough space. There are big blocks like u use at dentist which wedge between hour teeth on the side/back but I'm scared she will swallow it. For now I just stuffed the heck out of a curlex which seems to be working. Advice?

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[Nuriko]

Aside from bite blockade, I would start working the patient up for delirium. How long have they been on ECMO? Scheduling a low dose anti-psychotic of your choice would probably be a reasonable place to start. Not knowing any more about her condition, I would also rule out sepsis, hepatic failure, etc as secondary causes and go from there.

 

[europeman]

Hi.

I appreciate your response. We are well passed that stage. Bite block how? Back of mouth? She's as critically I'll as it gets. Everything u described has been amd continues to be done. The question is simply about the tongue


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[Daiphon]

Hi.

I appreciate your response. We are well passed that stage. Bite block how? Back of mouth? She's as critically I'll as it gets. Everything u described has been amd continues to be done. The question is simply about the tongue


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If trach'd and no PO intake and not vomiting risk, may consider wiring the jaw shut... conceivably, risks < benefits.

 

[Phlegm]

Botox to the masseter muscles, will save the tongue but a feeding tube would be required for while.

 

[europeman]

That's a unique idea!

Haha :

Wow.

We just did the curlex shoved in mouth method and it's working

 

[slycaper]

I had a pt present similarly after a head injury and she ended up getting her jaw wired by OMF for a couple weeks until her mentation cleared and had it removed. In the interim we had the family purchase a mouth piece (typical football/boxing type mouthpiece) that worked well until the wiring.

 

[europeman]

My patient is intubated though presumably yours is not?

 

[slycaper]

My patient is intubated though presumably yours is not?

She was nasotracheally intubated for facial fx repairs ended up having to go back to get her jaw wired d/t tongue biting