pulmonary aspiration and drowning

Question 1

what is pulmonary aspiration

Answer 1

passage of fluids or solids into the lung

- either endogenously produced secretion or exogenous substances into airway beyond vocal cords

Question 2

what are the 3 categories of pulmonary aspiration risk factors?

Answer 2

Altered LOC
CNS abnormality
Structural lesions:

other
CPR
GERD
tracheostomy 
vomiting

Question 3

what cause altered LOC

Answer 3

• Alcohol
• Drugs
• Trauma
• CVA(stroke)
• NM weakness

Question 4

What cause CNS abnormality

Answer 4

• Myasthenia gr.
• Guillain Barre
• ALS

Question 5

What cause structural lesion

Answer 5

• TracheoEsophagous Fistula (congenital)

- Tumors

Question 6

what is EA?

Answer 6

esophagus atresia

• esophagos is shorten, closed off
• occurs in conjunction with tracheoesophageal fistula

Question 7

what is aspiration pneuonitis

Answer 7

aspiration of gastric acid

If ph <2.5 and volume of 1ml/kg, will cause sigificant lung injury

if ph 1 - 1.5 , then parencyhmal dmg occur with inflammation, edema and hemorrhage

Question 8

what is the clinical presentation of aspiration pneomonitits

Answer 8

2- 6- post aspiration

S&S commonly missed as acute inflammation might not occur hours after

Question 9

What is the ABG finding for aspiration pneomonitits

Answer 9

early: alveolar hyperventilation with hypoxemia

late/severe: metabolic or respiratory acidosis with severe hypoxemia

Question 10

what is the treatment?

Answer 10

oral suction –>intubate
BAL
ventilate with PEEP

Question 11

What is foregin body aspirtaion

Answer 11

common aspiration in children between age 1 - 3

object lodge in right lung

Question 12

treatment for FBA

Answer 12

broncho or laryngoscope to see

Question 13

what are the key risk factors of drowning

Answer 13

male
>14yrs

alcohol use
low income
poor education
risky behavior
no supervision 
no aquatic exposure

Question 14

what is drowning

Answer 14

death by asphyxia

–>body deprived of O2

Question 15

what is wet drowning

Answer 15

water in the lung

Question 16

what is dry drowning

Answer 16

no water in the lung

- due to reflex of larygealspasm

Question 17

what is salt water drowning

Answer 17

seawater aspiration lead to pulmonary edema

shifts of electroylyte can cause hypernatremia

Question 18

what is fresh water drowning

Answer 18

aspiration of hyperosmolar water –> comprmised surface tension

• ->atelectasis
• ->shunt

Question 19

what are the S&s of drowning

Answer 19

take 1 - 72 hrs to appear

• lethargy or extreme fatigue
• difficulty breathing and cough
• irritability/mood swing
• chest pain

Question 20

what is water intoxification

Answer 20

rapid increase intake of water, causing extracellular fluid rushing to cell, causing rupture of cell

Question 21

S&S of water intoxification

Answer 21

swelling of brain & nerves
irregular HB
confusion
fatigue

Question 22

pathophysiology of wet drowning

Answer 22

Panic
voluntary breath hold
decrease Po2, incnrease Paco2

stimuate respiratory center
inhale H2O

Question 23

what are the sequence of drowning sequence

Answer 23

1. panic and violent struggle
2. period of calmnesss and apnea
3. swollening of fluid then vomit
4. gasping air and aspiration
5. convulsion
6. coma
7. death

Question 24

what is the effect of hypothermia?

Answer 24

lead to increase survival

core cooling provide protective effect

• ->decrease BMR, decrease anoxia
• ->decrease 10 degre decrease ATP consumption by 50%

Question 25

what is the rxn for hypothermia

Answer 25

appear to be pulseless due to bradycardia and vasoconstriction

hypothermic heart is irritable–prone to ven F

Question 26

how to treat hypothermic patient <35 degree

Answer 26

passive warming: remove wet clothes

Question 27

how to treat hypothermic patient 32-35 degree

Answer 27

active and passive warming: bair huggar , blanket

Question 28

how to treat <32

Answer 28

active internal warming via warm IV fluid, stomach and rectal lavage