Aspiration for Certified Emergency Nursing (CEN)

Aspiration

Definition/Etiology:

Exogenous material or endogenous secretions are inhaled into the respiratory tract. Aspiration pneumonia is the number cause of death for dysphagia (difficulty swallowing) patients with neurological disorders.

Causes:

• Reduced conscious level
• Impaired cough reflex
• alcohol/drug overdose
• Post-seizure
• Post-anaesthesia
• Stroke/CVA
• Muscle weakening disorders (myasthenia gravis)

Pathophysiology:

Most pneumonias are a result of aspiration of micro-organisms from the oral cavity or nasopharynx. High correlation between volume of aspirate and the risk of developing pneumonia.

Clinical Presentation:

Consider amount and nature of the aspirated material (food worse than water), the site and frequency of the aspiration.

• Dyspnea
• Cough
• Pain (best, back, abd)
• Tachypnea, tachycardia
• Fever/chills
• AMS for elderly
• Decreased breath sounds

Collaborative Management:

Diagnostics:

• WBC
• Cultures
• ABGs
• Chest Xray

Interventions:

• Stable – sent home with antibiotics, bronchodilators, oral hydration
• Admitted/Unstable – antibiotics, ABCs, IV fluids, bronchodilators
  • Airway management – O2, CPAP
  • BiPAP, intubation as required

Evaluation | Patient Monitoring | Education:

• ABCD
• Breath sounds and pulse oximetry
• Cardiac rate and rhythm
• Hemodynamic status
• Level of consciousness

High alert for SEPSIS!

Linchpins: (Key Points)

“Went down the wrong pipe!”

• Foreign material or secretions enter respiratory tract causes pneumonia
• Caused by neuro issues or muscle weakness
• Protect the airway, treat the pneumonia