Aspiration of Gastric Contents Flashcards
What is aspiration of gastric contents?
The presence of liquid or particulate matter that originates from the stomach in the tracheobronchial tree.
What are the clinical features of aspiration of gastric contents?
cough/laryngospasm bronchospasm hypoxemia tachypnea if breathing spontaneously increased airway pressures
What is the differential diagnosis for suspected aspiration of gastric contents?
hypoxemia from other causes asthma/bronchospasm pulmonary edema/ARDS pulmonary embolism increased airway pressures from other causes
What is the management of aspiration of gastric contents from immediate occurrence onward?
- trendelenburg positioning
- suction pharynx with rigid suction (remove - large pieces with mcgills if necessary)
- maintain cricoid pressure
- intubate with cuffed ETT
- ventilate with 100% O2, then titrate to SpO2 > 95%
- pass soft suction catheter down ETT but - - if SpO2 falls, do not persist
- assess for bronchospasm, cyanosis, difficulty ventilating, pulm edema
- support circulation (there can be extraordinary fluid loss through pulmonary edema)
albuterol - once resuscitation done, consider bronchoscopy
- postpone abbreviate surgery if gross aspiration
- no evidence supporting empirical antibiotics – manage based on results of gram stain of pulmonary aspirate
- steroids not routinely recommended
- CXR in PACU
Would you give steroids as part of the treatment/resuscitation of aspiration of gastric contents?
Steroids are not routinely recommended.
What antibiotics would you give empirically for aspiration of gastric contents?
No evidence supports empirical antibiotics for aspiration of gastric contents. They should be chosen based on results of the gram stain of the pulmonary aspirate.
How might aspiration of gastric contents cause hypovolemia?
There can be marked fluid losses through pulmonary edema.
