Aspiration Flashcards
1
Q
What risk factors pre-dispose to possible aspiration?
A
- Inadequate anaesthesia
- Pregnancy
- Obesity
- Difficult airway
- Emergency surgery
- Full stomach
- Altered GI motility
2
Q
Which patients are likely to have delayed gastric emptying?
A
- Metabolic disease (poorly controlled DM, renal failure, sepsis)
- Decreased motility (head injuries, myotonias)
- Pyloric obstruction
- GORD
- Raised intra-abdominal pressure (obesity, pregnancy)
- Opioids
- Trauma (includes ileus from recent GI surgery)
3
Q
What are the signs of possible aspiration?
A
- Obvious regurgitation
- Gastric contents in airway device or oropharynx
- High airway pressure and wheeze
- Laryngospasm
- Respiratory distress
- Desaturation
4
Q
Outline a management plan for suspected aspiration
A
- Apply cricoid unless pt is actively vomiting
- Call for help
- Position head down and (L) lateral
- Suction the pharynx/larynx
- Secure the airway and suction out the ETT
- Ventilate with 100% O2
- Expect bronchospasm and treat as appropriate
- Insert NGT and empty stomach
- Cancel elective surgery, proceed with emergency surgery
- Decide whether aspiration is significant
5
Q
What suggests a likely significant aspiration?
A
- Solid materal suctioned from trachea
- Contaminated aspirate
- Metabolic acidosis
- Ongoing hypoxia, chest signs, need for ventilatory support
6
Q
What subsequent management may be necessary for a patient post aspiration?
A
- Perform bronchoscopy and admit to ICU if significant aspiration
- Document
- Medical review if pt discharged to ward
- CXR
- No evidence to support routine ABs or steroids
7
Q
What measures can be used to decrease the risk of pulmonary aspiration?
A
- Fasting
- Chemical control of gastric acidity
- Prokinetics
- RSI with adequate cricoid pressure*
- Suction readily available