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Gastric Content Aspiration

Gastric Content Aspiration

Medical Emergencies

Aspiration of gastric contents into the lower respiratory tract can occur in sedated or unconscious patients and in case of topical anaesthesia of oropharynx, as there is a decreased gag reflex. This can lead to serious respiratory difficulties.

  • The low pH (high acidity) of gastric content can necrotise the pulmonary tissue, followed by a respiratory distress syndrome, with transudation of fluid into pulmonary alveoli and loss of functioning lung tissue.
  • The particulate matter in gastric contents causes physical obstruction of pulmonary airways.

Clinical findings

Signs of imminent vomiting

  • Nausea.
  • Feeling of warmth.
  • Frequent swallowing.
  • Feeling of anxiety.
  • Perspiration.
  • Gagging.

Signs of aspiration

  • Tachypnea, wheezing.
  • Tachycardia and hypotension.
  • Cyanosis.
  • Respiratory failure (refractory to BLS).

Prevention

  • Instruct the patient not to eat or drink for 8 hours before any treatment that involves moderate or deep sedation.

  • If the sedated or unconscious patient begins to vomit or exhibit any signs of imminent vomiting :

    • Place the patient into a head-down, feet-raised position immediately.
    • Turn the patient onto the right side and encourage oral drainage of vomitus.
    • Use high-volume suction to remove vomitus from the oral cavity.

Management

  • Terminate all dental treatment.
  • Place the patient onto the right side with head down and feet raised.
  • Suction the oropharynx.

If there are no symptoms of aspiration : Monitor vital signs for 30 minutes.

Symptoms of aspiration are present :

  • Call for medical assistance.
  • Administer oxygen.
  • Start IV line and administer normal saline or 5% dextrose in water at 150 ml per hour.
  • Monitor vital signs.
  • Shift to emergency care facility.

Signs of Hypoxia

  • Perform endotracheal intubation.
  • Provide pulmonary lavage with normal saline and positive pressure oxygen.
  • Administer Theophylline (250 mg) IV slowly.
  • Start Basic Life Support (BLS), if breathing ceases.

References

  • Contemporary Oral and Maxillofacial Surgery (6th Edition), James R Hupp, Edward Ellis III, Myron R Tucker, Mosby Elsevier. https://amzn.to/3HJehMO

*This article is an excerpt from the above mentioned book and Medical Sutras does not make any ownership or affiliation claims.