Aspiration
Theory
Aspiration of gastric contents into the pulmonary alveolar spaces leads to a severe chemical pneumonitis involving gram negatives and gram positives including staph aureus and possibly MRSA.
There is a spectrum of severity from severe pneumonia to ARDS and cardiopulmonary collapse.
Patients who are weak, unwell, debilitated, elderly or who have an altered conscious state are predisposed to aspiration.
Anatomical predisposition to the apical segment in right lower lobe due to its anatomical position.
Immediate intern management
Attend patient and make rapid assessment.
If patient unconscious/severe respiratory distress/respiratory arrest
- Tell nursing staff to call Code Blue then move to head end of bed.
- Perform triple manoeuvre – chin lift, jaw thrust, head tilt.
- Clear mouth – suction secretions, vomitus.
- Insert Guedel airway/nasopharyngeal airway and administer oxygen.
- Bag and mask patient until help arrives.
- Intubate and insert cuffed ETT.
If patient conscious
- Clear airway of secretions with suction or by turning patient on their side.
- Perform basic airway manoeuvres to assist patient in obtaining a clear airway.
- Administer oxygen by mask to maintain oxygen saturations.
- Perform continuous pulse oximetry.
- Carry out rapid clinical assessment.
- Insert IV line and take set routine blood tests, including ABGs.
- Inform unit registrar of events.
Other options to be considered
- Insert nasopharyngeal airway.
- Attempt to suction lungs.
- Endotracheal intubation/flexible bronchoscopy.
- Direct tracheal suction.
|
Predisposing conditions
- Altered conscious state
- Alcoholism/drug OD
- Seizures/CVA
- GA/endoscopy/bronchoscopy
- Trauma
- Mechanical conditions
- Bowel obstruction
- ETT/NGT
- Tracheostomy
- Oesophageal disorders (stricture/fistulae/GORD)
- Impaired swallow (post CVA)
- Neurological conditions
- Multiple Sclerosis
- Myasthenia
- Parkinson’s
- Dementia
Clinical features (obtain rapidly)
History
- Basic information about patient – reason for admission, medical problems
- Events surrounding incident
- Sudden SOB/cough
- Vomiting
- Recent drug administration/operation
Examination
- Signs respiratory distress
- Low oxygen saturations and tachypnoea
- Fever (late sign)
- Decreased air entry at bases especially right
Underlying predisposition
- Generally unwell/debilitated
- Altered conscious state
- Neurological conditions
- Bowel obstruction
Investigations
- ABG
- CXR
- Basic blood tests
- Sputum and blood cultures
Further definitive management
- Consider ICU admission if high oxygen demands or if unstable
- IV antibiotics
- Ceftriaxone and metronidazole
- Imipenem and vancomycin
- NGT if has bowel obstruction
- Respiratory support
- BiPAP, CPAP, intubation and ventilation
In setting of ARDS:
- There is a role for steroids – IV hydrocortisone (would be decided in conjunction with ICU and medical staff)
Back