Aspiration Flashcards

1
Q

What risk factors pre-dispose to possible aspiration?

A
  1. Inadequate anaesthesia
  2. Pregnancy
  3. Obesity
  4. Difficult airway
  5. Emergency surgery
  6. Full stomach
  7. Altered GI motility
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2
Q

Which patients are likely to have delayed gastric emptying?

A
  1. Metabolic disease (poorly controlled DM, renal failure, sepsis)
  2. Decreased motility (head injuries, myotonias)
  3. Pyloric obstruction
  4. GORD
  5. Raised intra-abdominal pressure (obesity, pregnancy)
  6. Opioids
  7. Trauma (includes ileus from recent GI surgery)
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3
Q

What are the signs of possible aspiration?

A
  1. Obvious regurgitation
  2. Gastric contents in airway device or oropharynx
  3. High airway pressure and wheeze
  4. Laryngospasm
  5. Respiratory distress
  6. Desaturation
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4
Q

Outline a management plan for suspected aspiration

A
  1. Apply cricoid unless pt is actively vomiting
  2. Call for help
  3. Position head down and (L) lateral
  4. Suction the pharynx/larynx
  5. Secure the airway and suction out the ETT
  6. Ventilate with 100% O2
  7. Expect bronchospasm and treat as appropriate
  8. Insert NGT and empty stomach
  9. Cancel elective surgery, proceed with emergency surgery
  10. Decide whether aspiration is significant
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5
Q

What suggests a likely significant aspiration?

A
  1. Solid materal suctioned from trachea
  2. Contaminated aspirate
  3. Metabolic acidosis
  4. Ongoing hypoxia, chest signs, need for ventilatory support
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6
Q

What subsequent management may be necessary for a patient post aspiration?

A
  1. Perform bronchoscopy and admit to ICU if significant aspiration
  2. Document
  3. Medical review if pt discharged to ward
  4. CXR
  5. No evidence to support routine ABs or steroids
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7
Q

What measures can be used to decrease the risk of pulmonary aspiration?

A
  1. Fasting
  2. Chemical control of gastric acidity
  3. Prokinetics
  4. RSI with adequate cricoid pressure*
  5. Suction readily available
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