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patient assessment ii exam 1 > High Risk Aspiration Patients > Flashcards

High Risk Aspiration Patients Flashcards

1
Q

Drawing of a foreign substance, such as gastric contents into the respiratory tract

A

Aspiration (doesn’t allow lungs to exchange)

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2
Q

Contents involved in aspiration include

A

secretions, blood, gastric contents, or a foreign body

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3
Q

Aspiration leads to

A
  1. aspiration pneumonitis (what we care about)

2. aspiration pneumonia

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4
Q

When material is acidic gastric contents, the patients is at risk for

A

aspiration pneumonitis

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5
Q

When when is oral secretion containing bacteria, the patient is at risk for

A

aspiration pneumonia

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6
Q

Aspiration pneumonitis is a type of

A

acute lung injury

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7
Q

1st phase of aspiration pneumonitis consist of

A

chemical burning of lung tissue, peaking 1-2 hours after event

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8
Q

2nd phase of aspiration pneumonitis consists of

A

massive inflammatory response (peaks 4-6 hours after event)

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9
Q

Severity of aspiration pneumonitis is dependent upon

A

VOLUME AND ACIDITY

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10
Q

What volume/pH is aspiration most severe

A

> 25 mL

pH < 2.5

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11
Q

Prevalence of aspiration

A

1/900 to 1/10,000

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12
Q

Aspiration results in what % of airway related deaths

A

50% (higher than CVCI!)

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13
Q

Why might aspiration be so prevalent and detrimental

A

lack of adequately identifying risk and modifying anesthetic technique

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14
Q

Aspiration can result in

A
  • dyspnea
  • hypoxia
  • hypercapnia
  • acidosis
  • respiratory arrest (causing stress on heart causing dysrhythmias)
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15
Q

Who is at risk for aspiration

A
  • technically everyone
  • upper esophageal sphincter issues
  • lower esophageal sphincter issues
  • bad airway reflexes (trouble cough, swelling, L-spasm)
  • too light anesthetic
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16
Q

Why is everyone technically at risk for aspiration

A

drugs used to produce and maintain GA greatly reduce the body’s natural defense against aspiration

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17
Q

What demographic has decreased airway reflexes

A

elderly

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18
Q

Why would too light an anesthetic cause aspiration

A

pain can cause gagging/retching and can increase gastric pressure over LES pressure

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19
Q

In aspiration events, regurgitation occurs how many times as often as active vomiting

A

3x

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20
Q

What can we do to help aspiration

A
  1. identify risk factors
  2. reduce risk
  3. execute modified anesthetic techniques
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21
Q

High risk factors for aspiration

A
  1. full stomach
  2. decreased gastric emptying
  3. esophageal sphincter impairment
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22
Q

What types of patients are likely to have a full stomach

A
  1. NON-NPO
  2. emergency/trauma
  3. small bowel obstruction
  4. pregnancy
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23
Q

Highest risk for aspiration

A

small bowel syndrome

24
Q

What types of patients are likely to have decreased gastric emptying

A
  1. diabetic
  2. recent trauma
  3. opioid use
  4. increased ICP
  5. pregnancy
25
Q

What types of patients are likely to have esophageal sphincter impairment

A
  1. GERD
  2. morbid obesity
  3. hiatal hernia
  4. pregnancy
  5. pyloric stenosis
26
Q

Clear liquids NPO hours

A

2

27
Q

Breast milk NPO hours

A

4

28
Q

Nonhuman milk NPO hours

A

6

29
Q

Light meal NPO hours

A

6

30
Q

Regular/hearty meal NPO hours

A

8

31
Q

Disorder which slows the movement of food from stomach through pylorus into small intestine

A

gastroparesis (decreased gastric emptying)

32
Q

(Decreased gastric emptying) Gastroparesis most often associated with

A

injury to vagus nerve or idiopathic

33
Q

What types of people are likely to have gastroparesis (decreased gastric emptying)

A
  • poorly controlled diabetics
  • severe pain
  • Parkinson’s or MS
34
Q

When part of the stomach bulges through diaphragm into chest

A

hiatal hernia (lower sphincter issues)

35
Q

Thickened pylorus muscle preventing food from traveling from stomach to small intestine

A

pyloric stenosis (esophageal sphincter impairment)

36
Q

Cases of esophageal sphincter impairment

A

hiatal hernia

pyloric stenosis

37
Q

Demographic commonly associated with pyloric stenosis

A

pediatrics

38
Q

How can we reduce risk of aspiration

A
  1. decrease gastric volume
  2. decrease gastric pH
  3. stop surgery if possible
  4. regional with MINIMAL sedation
39
Q

Drugs used to decrease gastric volume

A
  1. reglan (metoclopramide)
  2. erythromycin
  3. NG tube
40
Q

Reglan (metoclopramide) method of action and onset

A
  • increases gastric motility/emptying to decrease gastric volume. Also increases pH
  • onset 1-3 min
  • dopamine antagonist
41
Q

Erythromycin method of action

A

antibiotic that promotes gastric emptying

42
Q

Drugs used to increase gastric pH (decrease acidity)

A
  1. H2 blockers
  2. Proton pump inhibitors (PPIs)
  3. Antacids
43
Q

When is reglan contraindicated

A

Parkinson’s disease treated with L-Dopa or in presence of small bowel obstruction

44
Q

Common H2 blocker used to increase gastric pH (decrease acidity)

A

pepcid (famotidine)

- what we usually give

45
Q

Antacid used to increase gastric pH (decrease acidity)

A

Sodium citrate (citric acid, bictra; alkalizing salt)

46
Q

Proton pump inhibitor used to increase gastric pH (decrease acidity)

A

omeprazole (or other prazoles)

- usually prescribed

47
Q

H2 antagonists (like blockers) method of action

A

competitively inhibit action of histamine at H2 receptors on gastric parietal cells, inhibiting gastric acid secretion
- blockers do NOT alter pH of gastric fluid already present in stomach at time of admin

48
Q

onset of H2 blockers

A

30 minutes

49
Q

How can we execute modified anesthetic techniques

A
  1. RSI

2. modified RSI (high dose Roc over Sux)

50
Q

Why do we hold posterior pressure on cricoid cartilage during an RSI

A

to prevent regurgitated contents from traveling up any higher

51
Q

Sux dose used in RSI

A

1-2 mg/kg (on side of 2)

52
Q

Roc dose used for RSI

A

0.6-1.2 mg/kg

53
Q

Why do we not ventilate while waiting for drugs to take effect in RSI?

A

so we don’t push more air into their stomach?

54
Q

The airway is never protected (but especially in RSI) until this happens

A

cuff is inflated

55
Q

BURP versus cricoid pressure

A

Cricoid pressure is used to protect the airway from regurgitated contents while BURP is used attempting to gain better view of vocal cords during intubation

56
Q

BURP stands for

A

backward
upward
right
pressure

57
Q

Things you MUST do before extubating an RSI/any concern with stomach

A
  1. suction out stomach (OG or NG)

2. awake extubation with return of airway reflexes (get academic with it)

patient assessment ii exam 1 (3 decks)

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