CONSEQUENCES OF ASPIRATION

Question 1

What is the definition of aspiration ?

Answer 1

Aspiration is defined as the entry of foreign material into the airway below the vocal folds.

Question 2

What is the epidemiology of foreign body aspiration ?

Answer 2

*80% occur in children
*80% of the paediatric cases occur to
those between the ages of 1 and 2

Question 3

What are the locations of aspirated foreign body distribution ?

Answer 3

• Right lung: 60%
• Left lung: 23%
• Trachea: 13%
• Larynx: 3%
• Bilateral: 2%

Question 4

What is the clinical presentation of partial obstruction ?

Answer 4

• Cough, Wheeze,Dyspnoea
• Chest pain and Choking
• Drooling and Inspiratory stridor on
  auscultation.

Question 5

What is the clinical presentation of complete obstruction ?

Answer 5

• Unable to cough or
  speak
• Loss of consciousness

Question 6

What is the Dx work up in foreign body aspiration ?

Answer 6

• CXR and if it is negative and there is still clinical suspicion CT.

Question 7

What is the management of foreign body aspiration ?

Answer 7

• If it is outside hospital chest thrust, abdominal thrust and back blows in small kids.
• In hospital bronchoscopy.

Question 8

What is aspiration pneumonitis ?

Answer 8

Aspiration pneumonitis is acute lung injury after the inhalation of regurgitated sterile gastric
contents. This generally occurs in patients with an altered level of consciousness.

Question 9

What is the presentation of aspiration pneumonitis ?

Answer 9

• Initially can be asymptomatic and in 2 to 5 Hrs the patient may present with Non-productive cough, Tachypnoea
  and Crackles/ Wheezing on auscultation. They may also have Marked decreased level of consciousness.

Question 10

What is aspiration pneumonia ?

Answer 10

It is commonly seen in elderly. It develops after the inhalation
of colonized oropharyngeal
material. Colonised secretions from
the oropharynx is the primary
mechanism by which bacteria gain entrance to the lungs.

Question 11

What are the main predisposing factors for aspiration pneumonia ?

Answer 11

Dysphagia and Gastric dysmotility

Question 12

What are the signs and symptoms of aspiration pneumonia ?

Answer 12

*Cough, purulent sputum and fever.
* Dyspnoea and Dysphagia.

Question 13

What is the diagnostic approach to aspiration pneumonia ?

Answer 13

*Clinical presentation
* Risk factors for aspiration
* Patient setting (Home, nursing home, hospital)
* Chest imaging

Question 14

What is the most common location of aspiration pneumonia ?

Answer 14

Right lower lobe.

Question 15

What is the out patient management of aspiration pneumonia ?

Answer 15

• Augmentin 875/125 mg or 2000/ 125 mg in ER.
• If penicillin allergy Moxifloxacin 400 mg once / day or clindamycin 300 to 450 mg 8 hourly.

Question 16

What is the in patient management of severe aspiration pneumonia ?

Answer 16

• Blood cultures and susceptibility testing , sputum gram staining.
• Empirical therapy with Piperacilin- tazobactum 4.5 gm IV/ 6 hrs.
• Imepenam 500 mg IV / 6hrs.
• Meropenam 1gm IV/ 6hrs.

Question 17

What is the in patient management of non severe aspiration pneumonia ?

Answer 17

• Blood cultures and susceptibility testing , sputum gram staining.
• Ampicilin- sulbactum 1.5 to 3 gm / 6hrs.
  If penicillin allergy:
• Ceftriaxone 1 or 2 gms / IV daily
• Cefotaxime 1 or 2 grams IV / 8 hourly.
  +
  Metronidazole 500 mg IV / 8hours.

Question 18

What is the cure rate of aspiration pneumonia with antibiotic therapy ?

Answer 18

76-88% with remainder ICU admission for ventilation and mortality.