Please enable JavaScript.
Coggle requires JavaScript to display documents.
Aspiration (Treatment (Monitor in appropriate area (Admit if day case,…
Aspiration
Treatment
Remove cause
Suction and NGT
Secure airway
Suction prior to ventilating
FiO2 for oxygenation
Consider bronchoscopy to remove debris
CXR
No indication for Abs or steroids unless infection
Monitor in appropriate area
Admit if day case
Consider ICU if requiring high pressures/intubation/FiO2
Risk Factors
pH <2.5 Stomach volume >25ml
Patient
Delayed gastric emptying
Trauma
Diabetes
Anti-cholinergics
Opioids
Intestinal obstruction
ETOH ingestion
Anxiety/Pain - SNS stimulation
Increased intra-abdominal pressure
Pregnancy
Obesity
Abnormal sphincter/anatomy/reflexes
Hiatus hernia
Oesophageal pathology
Gastric band/gastric sleeve surgery
GORD
Stroke/neurology
Sedative drugs
Unfasted or blood in airway
3hrs for breast milk
4hrs for formula
6hrs light meal
8hrs fatty meal
2hrs clear fluids
Surgery/Pathology
Emergency surgery
Upper GIT surgery
Lithotomy or head down positioning
Anaesthetic
Supraglotttic devices
Difficult or prolonged BMV
Light anaesthesia
Prevention
Pre-operative
Non-pharmacological
Delay surgery
Fast sufficiently
Gastric decompression - NGT suction
Regional > GA
Pharmacological
Rapid
IV Ranitidine 30mins
Metoclopramide IV 10mg (15mins)
Na citrate (NON particulate): minutes
Risk of severe pneumonitis is aspirate particulate
Slower
IV pantoprazole 1hr
PO Ranitidine 90-120mins
Increased efficacy if BD night before
PO Omeprazole 3hrs
Intraoperative
Intubate > supraglottic airway
RSI > normal
Avoid inflation pressures >20cmH2O
Post-operative
Extubate awake with airway reflexes
Position: lateral or head up
Suction prior
Decompress stomach prior to extubation
Anti-emetic: ideally pro-kinetic
Analgesia
Full reversal