Bb Aspiration

Front 1

How do patient's tolerate fecal aspiration?

Back 1

mortality is high from fecal aspiration secondary to pna and septic shock and often in spite of treatment, includes steroids and antibiotics

Front 2

What are the chief features of particulate aspiration?

Back 2

1. airway obstruction
2. atelectasis
-bronchial lavage can be helpful

Front 3

What is mendelson's syndrome? What are CXR findings?

Back 3

aspiration of gastric acid with development of:
1. pulm edema,
2. pulm htn,
3. cyanosis
4. decreased pulmonary compliance,
5. hypoxemia secondary to right to left intrapulmonary shunt
-CXR is mottled

Front 4

What are the results of gastric acid aspiration? What is the most consistent manifestation?

Back 4

destruction of surfactant producing cells and damage to pulmonary capillary endothelium resulting in:
1. atelectasis,
2. pneumonitis
3. ARDS
-arterial hypoxemia is the most consistent manifestation

Front 5

What is the typical pH and volume of gastric aspiration?

Back 5

at least 25 mL (or > 0.4 cc/kg) and pH <2.5

Front 6

What are symptoms of aspiration? When does radiograph evidence begin to show?

Back 6

1. bronchospasm,
2. wheezing,
3. tachypnea,
4. coughing,
5. dyspnea,
6. cor pulmonale secondary to pulm htn,
7. arterial hypoxemia is often not relieved by oxygen therapy,
8. pink frothy pulmonary exudate is characteristic of aspiration,
9. PCWP is often decreased secondary to loss of fluid through the pulmonary capillaries,
-radiograph may not show evidence until after 6-12hrs - evidence most often seen in RLL

Front 7

What are the physiologic effects of reglan?

Back 7

1. increases LES pressure,
2. decreases pyloric pressure,
3. speeds gastric emptying
4. can also antagonize dopamine leading to EPS

Front 8

In what patients have the gastric emptying effects of reglan proven to be beneficial?

Back 8

1. patients who have eaten
2. trauma
3. obese
4. pregnant
5. outpatients

Front 9

When should you not use reglan?

Back 9

patients with or are on:
1. phenothiazines,
2. butyrophenones,
3. TCAs,
4. MAOIs,
5. patients with SBO,
6. patients with pheochromocytoma (can release catecholamines from the tumor)

Front 10

What are the side effects of cimetidine by system?

Back 10

1. Heart - bradycardia, heart block, cardiac arrest
2. Lungs - increased airway resistance (blocks H2 receptors leaving H1 receptors unopposed),
3. CNS - confusion, agitation, hallucinations, seizures,
4. Liver - retard metabolism and excretion of several drugs (drugs that are highly metabolized on first pass through liver: digitalis, propranolol, meperidine, pentazocine, aminophylline, verapamil, lidocaine)

Front 11

What is the onset, duration, and dose of cimetidine?

Back 11

onset - 45min,
duration - 4 hrs
dose - 300 mg IV Q4-6hrs

Front 12

What is the onset and duration of reglan?

Back 12

PO 30-60 min,
IV 1-3 min
Duration 1-2 hrs

Front 13

How does ranitidine compare to cimetidine? What are doses of each?

Back 13

5x more potent, longer acting (8 hrs compared to 4 hrs)
ranitidine 150 mg PO,
cimetidine 300 mg IV

Front 14

What are some complications of ranitidine?

Back 14

Has fewer side effects than cimetidine.
Mainly CV - hypotension, arrhythmias, bradycardias, cardiac arrest

Front 15

What is the benefit of using famotidine compared to other H2 blockers?

Back 15

not associated with cardiovascular complications

Front 16

What is the typical dose of famotidine (pepcid)?

Back 16

PO 20-40 mg BID,
IV 20 mg Q12H

Front 17

What is the half life of zofran?

Back 17

3 hrs
-shorter in children and longer in the elderly

Front 18

What are side effects of zofran?

Back 18

1. headache,
2. constipation,
3. diarrhea,
4. mild elevations in LFTs,
5. rarely associated with EPS (drug is still considered safe in parkinsons),
6. can also cause QT prolongation in very high doses

Front 19

What is the most effective way to give zofran?

Back 19

more effective alone than in combination with other drugs
-in patients on cisplatin effect is enhanced with decadron

Front 20

What are complications of PPI?

Back 20

all very rare:
1. myalgias,
2. angioedema,
3. anaphylaxis,
4. dermatologic manifistations;
5. can interfere with hepatic enzymes, dose should be decreased in liver failure

Front 21

What are side effects of dolasetron?

Back 21

1. QT prolongation,
2. prolonged PR and JT intervals,
3. widened QRS

Front 22

What are some common misconceptions for treating aspiration?

Back 22

1. pulmonary irrigation - with NS can aggravate the damage caused by aspiration,
2. effectiveness of steroids - has not been demonstrated,
3. antibiotics - should not be given prophylactically - only administer based on positive cultures

Front 23

How do you treat meconium aspiration in a newborn with APGAR of 0-3?

Back 23

1. establish an airway - apply suction removing as much meconium as possible, ventilation with 100% O2,
2. start chest compressions in those pulseless or severely bradycardic (30:2 compression (100/min)/ventilation (1 sec/breath) ratio),
3. Check the EKG and defibrillate if necessary (2 Joules/kg),
4. umbilical artery catheterization - umbilical vein is easier but run the risk of liver damage
5. drugs management

Front 24

What are the ASA NPO guidelines? What type of liquid falls in each category?

Back 24

1. Clear liquids (carbonated or non, non alcoholic liquids such as fruit juices without pulp, clear tea, coffee, or water) - 2 hrs
2. Breast milk - 4 hrs
3. Infant formula/non-human milk - 6 hrs
4. Full liquids (liquids other than clear, non human milk, infant formula, juices with pulp) - 6 hrs
5. Light meals (non fatty, non fried ie toast) - 6 hrs
6. Heavy meals (fried foods, fatty foods, meat) - 8 hrs

Front 25

What is the treatmenf of aspiration?

Back 25

1. Head down
2. Suction
3. Intubation
4. Mechanical ventilation

Front 26

Reglan dose and onset

Back 26

5-10 mg PO/IV
Onset 30-60 min for PO
1-3 min for IV/IM

Front 27

What does Reglan not reliably do?

Back 27

It does not alter gastric pH

Front 28

Cimetidine MOA

Back 28

a competitive inhibitor of H2 receptors which block histamine induced secretion of H+ ions by gastric parietal cells

Front 29

What is the chief advantage of Sodium Citrate?

Back 29

Effectively raises gastric pH and is non-particulate, especially desirable in the setting of aspiration

Front 30

Zofran MOA

Back 30

a 5-HT3 receptor (serotonin) antagonist - both central and peripheral receptors are blocked and they appear to play an important role in the vomiting reflex

Front 31

Omeprazole MOA

Back 31

Proton pump inhibitor which binds to the H+ ion pump in gastric parietal cells and inhibits secretion of H+ ions

Front 32

Drug management in pediatric CPR

Back 32

Narcan 10 mcg/kg,
Atropine 20 mcg/kg,
Epi (1:10,000 ie 100 mcg/cc) 0.1 cc/kg,
Na Bicarb 1-2 mEq/kg in 10 cc D5W
Consider Ca and glucose

Front 33

Pts at increased risk for aspiration

Back 33

1. Delayed gastric emptying - diabetics, pain, bowel obstruction, prior opioids
2. Increased gastric volume - obesity, pregnancy, trauma
3. Disorders of GE sphincter - hiatal hernia, achalasia, esophageal tumors
4. Pts in PACU - airway reflexes are decreased secondary to opioids, NM block, and inh agents