Aspiration Flashcards
(18 cards)
What are the primary actions in managing acute gastric regurgitation/aspiration?
- Call for help.
- Turn patient’s head to the side (left lateral decubitus position).
- Suction gastric contents from oropharynx.
- Apply cricoid pressure to decrease additional gastric aspiration, but AVOID cricoid pressure during active vomiting.
- Immediate intubation.
- Suction trachea and bronchi via endotracheal tube before ventilation.
- Provide positive pressure ventilation with 100% FiO₂.
What are the secondary actions in managing acute gastric regurgitation/aspiration?
• Supportive ventilation strategy:
o Tidal Volume: 6-8 mL/kg
o PEEP: 5-10 cm H₂O
• Titrate FiO₂ to SpO₂ ≥ 90%, PaO₂ ≥ 60 mm Hg.
• Obtain baseline chest X-ray and arterial blood gas.
• Bronchoscopy for removal of aspirated solids causing obstruction.
What are the prevention strategies for acute gastric aspiration?
• Identify risk factors for gastric aspiration.
• Adhere to ASA NPO guidelines.
• Delay elective or non-emergent procedures in high-risk patients.
• Assess gastric volume using point-of-care ultrasound.
• Consider alternatives to general anesthesia.
• Use rapid sequence induction with cricoid pressure.
• Insert NG tube and provide suction if distention occurs.
• Suction oropharynx before extubation.
What medications are used for pharmacologic prevention of acute gastric aspiration?
• Metoclopramide: 10-20 mg IV, 20-30 minutes before induction.
• Famotidine: 20 mg IV, 60-90 minutes before induction.
• Sodium citrate: 15-30 mL PO, 20-30 minutes before induction.
What antibiotics are recommended for acute gastric aspiration?
• Broad-spectrum antibiotics for bacterial pneumonia.
• IV antibiotics based on blood cultures.
What hemodynamic support is needed in acute gastric aspiration?
• Vasopressor and/or inotropic support for hemodynamic compromise.
What physiological changes occur during induction related to aspiration risk?
During induction, upper and lower esophageal sphincters relax, increasing aspiration risk.
What are the types of aspiration?
- Chemical Aspiration Pneumonitis (Mendelson Syndrome)
- Mechanical Obstruction
- Bacterial Infection (Aspiration Pneumonia)
What are the patient-based risk factors for acute gastric aspiration?
• Full stomach
• Obesity
• Obstetric patients
• Nausea/Vomiting
• Lower esophageal sphincter tone
What are the pathophysiologic risk factors for acute gastric aspiration?
• Gastrointestinal obstruction
• Ascites
• Gastroparesis
• Diabetic gastroparesis
• Hiatal hernia
• Peptic ulcer disease
• Acute head injury
• Seizures
• Parkinson disease
What are the situational risk factors for acute gastric aspiration?
• Emergency surgery
• Prolonged difficult airway management
• Traumatic injury requiring surgical intervention
What are the respiratory signs and symptoms of acute gastric aspiration?
• Chest X-ray infiltrates.
• Dyspnea.
• Gastric secretions in oropharynx.
• Hypercarbia.
• Hypoxemia (earliest and most reliable sign).
• Increased positive inspiratory pressure.
• Rales/rhonchi.
• Tachypnea.
• Wheezing.
What are the cardiovascular signs and symptoms of acute gastric aspiration?
• Initial hypertension followed by hypotension if severe.
• Pulmonary hypertension.
• Tachycardia.
What are other considerations in acute gastric aspiration?
• Disseminated intravascular coagulation (DIC).
What are the differential diagnoses for respiratory issues in acute gastric aspiration?
• Acute respiratory distress syndrome (ARDS).
• Bronchospasm.
• Endotracheal tube migration/obstruction.
• Hypercarbia.
• Hypoxia.
• Pneumonia.
• Pulmonary edema.
• Pulmonary embolism.
• Upper respiratory tract infection.
What is the differential diagnosis for cardiovascular issues in acute gastric aspiration?
Congestive heart failure.
What are other differential diagnoses to consider in acute gastric aspiration?
Anaphylaxis.
What diagnostic tests are used for acute gastric aspiration?
• Chest X-ray.
• Arterial blood gas (ABG).
• Sputum cultures to identify pathogen.
