Keep in mind that this may not be the patient's first stroke. Previous strokes may have left the patient with disabilities, such as reduced mentation, the inability to swallow, or other physical handicaps that make it difficult to protect their airway. Strokes tend to occur in the elderly , who may already have physical limitations that make it difficult to position them for improved air exchange.
If the patient suffers from kyphosis anterior curvature of the spine or spinal stenosis, and is unable to lay flat, pad the backboard or stretcher and consider placing them in recovery position when appropriate. A patient suffering a head injury is also at risk for pulmonary aspiration. Not only may they have a reduced level of consciousness or be unresponsive, but the traumatic injury may produce bleeding in the oral or nasal cavity, which can easily be aspirated into the lungs. If the patient has a head injury, they may also have a spinal injury, so use a jaw thrust to open the airway and place the backboard on its side to use gravity to prevent pulmonary aspiration.
You may want to consider rapid sequence intubation for patients who still have a gag reflex but are unable to protect their airways. Alcohol overdose, also known as alcohol poisoning, presents a serious threat of pulmonary aspiration.
Alcohol overdose occurs when the blood alcohol level is so high that it interferes with the body's ability to perform basic functions, such as controlling body temperature, respiration, and heart rate.
Signs of alcohol poisoning include Consider using an advanced airway in patients suspected of alcohol poisoning, since the probability for vomiting is high, as is the chance for pulmonary aspiration. Each of these scenarios presents a likelihood of pulmonary aspiration. You must remain diligent when treating patients suffering from stroke, head injury, or alcohol poisoning, because each may involve a decreased level of consciousness and an unprotected airway.
One of the most important pieces of equipment for such scenarios is your portable suction unit. If the unresponsive patient or the patient with diminished consciousness begins to vomit, you have mere seconds to protect the airway.
All it takes is a single inhalation of vomit to expose the lungs to dangerous bacteria. If the suction isn't ready, the chance of preventing pulmonary aspiration is little to none. Bring the suction along on all ALS calls. We often do not know whether the predisposing factors described above really do increase the incidence of aspiration. Should all obese patients, all patients in the lithotomy position, or all those undergoing laparoscopic surgery particularly gynaecological surgery be regarded as at high risk?
How long can the airway be safely managed without increasing the risk of aspiration with a supraglottic airway? Is the incidence of aspiration truly higher during controlled ventilation through the laryngeal mask than during spontaneous breathing through it? There have been several reports of the use of the laryngeal mask and controlled ventilation without aspiration during laparoscopic cholecystectomy, 20 21 and during operations lasting several hours, 22 but the number of patients reported so far is too small to conclude that the incidence of pulmonary aspiration does not increase in these circumstances.
We do not know how high the risk of aspiration is for fasted patients. The traditional cut-off value of residual gastric volume greater than 25 ml and pH less than 2.
Determining more accurate cut-off values may now be more clinically relevant, because the laryngeal mask may encourage regurgitation by decreasing the lower oesophageal sphincter tone. Neither do we know whether the ProSeal laryngeal mask, which in theory reduces pulmonary aspiration, truly reduces the incidence and, if any, the degree of aspiration with this device. We do not even know the incidence of pulmonary aspiration during tracheal intubation in patients without predisposing factors.
It is therefore impossible to estimate whether the incidence of aspiration during use of the laryngeal mask is as low as the incidence during tracheal intubation in patients without predisposing factors.
In view of the uncertainties about the risk of pulmonary aspiration, it is inevitable that there are disagreements among anaesthetists on the use of supraglottic airways. If the patient aspirated in a circumstance, which some anaesthetists believe was a high risk for aspiration, there is a danger of the case being regarded as malpractice.
In this era of evidence-based medicine, the primary importance is to keep carrying out reliable research to reduce these uncertainties. Vomiting or laryngospasm will not occur when the patient is adequately anaesthetized, and thus aspiration after vomiting or with laryngospasm is no fault of the laryngeal mask, but rather of the anaesthetists who use it. Nowadays, neuromuscular blocking agents are given less frequently and the trachea is not intubated routinely.
We should therefore always be vigilant to adjust the depth of anaesthesia so that it is sufficiently deep to prevent airway or gastrointestinal motor reflexes. Brimacombe and colleagues' report 7 indicates that pulmonary aspiration can occur if we have failed to detect predisposing factors at a preoperative visit, and we use a supraglottic airway. Certainly, more systematic preoperative checking and more careful selection of patients are necessary before a supraglottic airway is used in preference to a tracheal tube.
In fact, the incidence of pulmonary aspiration of gastric contents can be high in critically ill patients who require mechanical ventilation. Pulmonary aspiration is the key factor that will determine the future of supraglottic airways, as the death toll from aspiration will continue to increase. We are standing at the test of time: it is still not too late to make further efforts to reduce the risk of pulmonary aspiration. Asai T, Shingu K. Should Mendelson's syndrome be renamed?
Anaesthesia ; 56 : —9. Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol ; 52 : — Sidaras G, Hunter JM.
Is it safe to artificially ventilate a paralysed patient through the laryngeal mask? The jury is still out. Br J Anaesth ; 86 : — Brimacombe JR, Berry A. The incidence of aspiration associated with the laryngeal mask airway: a meta-analysis of published literature.
J Clin Anesth ; 7 : — Aspiration during anaesthesia: a computer-aided study of anaesthetics. Acta Anaesthesiol Scand ; 30 : 84 — Clinical significance of pulmonary aspiration during the perioperative period.
Anesthesiology ; 78 : 56 — Aspiration and the laryngeal mask airway: three cases and a review of the literature. Br J Anaesth ; 93 : — Cooper RM. Can J Anaesth ; 50 : —3. Brimacombe J, Keller C. Anesth Analg ; 97 : —4. Asai T, Morris S. The laryngeal mask airway: its features, effects and role. Can J Anaesth ; 41 : — Berkshire: Intavent Research Limited, Drinking ml of clear fluid two hours before surgery has no effect on gastric fluid volume and pH in fasting and non-fasting obese patients.
Can J Anaesth ; 51 : —5. Strunin L. How long should patients fast before surgery? Time for new guidelines. Br J Anaesth ; 70 : 1 —3.
Use of the laryngeal mask is not contraindicated for laparoscopic cholecystectomy. Experts say the COVID pandemic added to the stresses of job insecurity and food shortages already felt by People of Color and young adults.
Health Conditions Discover Plan Connect. Mental Health. What Does Aspiration Mean? Medically reviewed by Debra Sullivan, Ph. Read on to learn what increases your risk for aspiration, complications, treatment, and more. What causes aspiration? Cause Result reduced tongue control This can fail to trigger the swallowing reflex. It tends to cause aspiration of liquids. They include gastroesophageal reflux disease GERD , dysphagia , and throat cancer. Silent vs.
What are the complications of aspiration? What increases your risk for aspiration? Aspiration in children. What will your doctor look for? Treatment for aspiration. Aspiration prevention tips. Read this next. Aspiration Pneumonia: Symptoms, Causes, and Treatment. Medically reviewed by Carissa Stephens, R. Meconium Aspiration Syndrome. Medically reviewed by Karen Gill, M. Medically reviewed by Sara Minnis, M. Down Syndrome.
Cerebral Palsy.
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