Pneumonia, Aspiration


Article Author:
Raghavendra Sanivarapu


Article Editor:
William Gossman


Editors In Chief:
Bette Bogdan
Lori Kerley
Robin Geiger


Managing Editors:
Frank Smeeks
Scott Dulebohn
Erin Hughes
Pritesh Sheth
Mark Pellegrini
James Hughes
Richard Ciresi
Phillip Hynes


Updated:
10/27/2018 12:31:23 PM

Introduction

The infectious pulmonary process that occurs after abnormal entry of fluids into lower respiratory tract is termed as aspiration pneumonia. The aspirated fluid can be formed from oropharyngeal secretions or particulate matter or can also be gastric content. The term aspiration pneumonitis refers to inhalational acute lung injury that occurs after aspiration of sterile gastric contents. In an observational study, it is found that the risk of patients hospitalized for community-acquired pneumonia in developing aspiration pneumonia is found to be about 13.8%. The mortality rate from aspiration pneumonia is largely dependent on volume and content of aspirate and can range to 70%.

Etiology

Failure of the natural defense mechanisms like the closure of glottis and cough reflex increases the risk of aspiration. The common risk factors for aspiration include altered mental status, Neurologic disorders, esophageal motility disorders, protracted vomiting and gastric outlet obstruction. Although the common organisms involved in etiology of community-acquired pneumonia are Streptococci, Haemophilus, and gram-negative bacilli, the etiology of aspiration pneumonia depends on the content of aspirate. A prospective study in 95 patients showed that gram-negative bacilli contributed to 49% followed by anaerobes (16%). The major anaerobes isolated were Fusobacterium, Bacteroides, and Peptostreptococcus. In hospital-acquired aspiration pneumonia, common etiology include gram-negative organisms specifically Pseudomonas auruginosa has to be considered.

Epidemiology

Due to lack of biomarkers the epidemiological studies to find the incidence of aspiration pneumonia has been difficult. Several studies showed that aspiration pneumonia contributes to 5% to 15% of all community-acquired pneumonia. A retrospective study done on 628 patients with aspiration pneumonia by Lanspa et al. showed a 30-day mortality of 21%. The study also showed that CURB 65 a predictor of mortality in Community-acquired pneumonia is not a reliable tool for aspiration pneumonia. Aspiration pneumonia remains one of the common complication following general anesthesia and occurs in one in every 2000 to 30000 cases. A study conducted on the elderly population aged older than 65 years who underwent cardiovascular surgery the incidence of aspiration pneumonia was found to be 9.8% with 12 out of 123 patients having aspiration pneumonia post-extubation. A case-control study conducted by Marrie TJ et al. showed that the incidence of aspiration pneumonia was 18% in nursing home patients and 15% in community-acquired aspiration pneumonia. Since most cases of aspiration pneumonia are silent or unwitnessed, the true incidence rate is difficult to calculate.

Pathophysiology

In normal healthy adults, the mucociliary mechanism and alveolar macrophages act as defenses in clearing micro aspirations from the oropharyngeal secretions. The pathological process of aspiration pneumonia occurs when the normal defenses mechanisms fail in a predisposed individual. The entry of fluid into the bronchi and alveolar space triggers an anti-inflammatory reaction with the release of proinflammatory cytokines, tumor necrosis factor alpha, and Interleukins. Inoculation of organisms of common flora from the oropharynx and esophagus results in the infectious process. Mendelson first studied the pathophysiology of aspiration pneumonitis by inducing gastric contents in rabbit’s lung and comparing to 0.1N hydrochloric acid. Later studies conducted in rats using diluted hydrochloric acid demonstrated the biphasic response with initial corrosive phase by acidic pH followed by a neutrophil-mediated inflammatory response. Inoculation of normal oropharyngeal flora in the aspirate results in infectious process and results in aspiration pneumonia. If the bacterial load of aspirate is low normal host defenses will clear the secretions and prevent infection.

History and Physical

The common clinical features that should raise suspicion for aspiration include sudden onset dyspnea, fever, hypoxemia, radiological findings of bilateral infiltrates and crackles on lung auscultation in a hospitalized patient. The common site involved depends on the position at the time of aspiration, commonly the lower lobes are involved in an upright position, and superior lobes can be involved in the recumbent position. The radiological findings will develop within 2 hours after aspiration and bronchoscopy can reveal erythematous bronchi.

Evaluation

A high level of suspicion should be made in diagnosing aspiration pneumonia, especially in critically ill hospitalized patients and antibiotic treatment should be initiated immediately, and imaging studies should not delay the treatment. The commonly utilized imaging studies are chest x-ray, computed tomography of the chest which will help in localizing the site of aspiration. However, most cases are unwitnessed aspiration which makes it very hard to distinguish between aspiration pneumonitis and aspiration pneumonia. Clinical features may help to distinguish. In aspiration pneumonitis, a large volume of gastric content has to be aspirated to produce chemical pneumonitis and can quickly progress to acute lung injury with subsequent development of acute respiratory distress syndrome (ARDS). Whereas, in aspiration pneumonia, aspiration can be of smaller volumes and can be unwitnessed which with inoculation of bacteria progress to features of pneumonia and subsequent development of acute respiratory distress syndrome (ARDS).

Treatment / Management

The treatment varies between aspiration pneumonia and aspiration pneumonitis. To prevent further aspiration, patient’s position should be adjusted followed by suction of oropharyngeal contents with the placement of the nasogastric tube. In patients who are not intubated humidified oxygen is administered and the head end of the bed should be raised by 45 degrees. A close monitoring of patients oxygen saturation is important and immediate intubation with mechanical ventilation should be provided if hypoxia is noted. A flexible bronchoscopy is usually indicated for large volume aspiration to clear the secretion and also for obtaining the sample of bronchoalveolar lavage for quantitative bacteriological studies. In general practice, antibiotics are initiated immediately even though are not required in aspiration pneumonitis to prevent progression of the disease. The choice of antibiotics for community-acquired aspiration pneumonia are ampicillin-sulbactam, or a combination of metronidazole and amoxicillin can be used. In patients with penicillin allergy clindamycin is preferred. However, in hospital-acquired aspiration pneumonia antibiotics that cover resistant gram-negative bacteria and S.aureus; so the use of a combination of vancomycin and piperacillin-tazobactam is most widely used. Once the culture results are obtained the antibiotic regimen should be narrowed to organism-specific.

Pearls and Other Issues

The disease syndrome that occurs after macro aspiration of gastric and oropharyngeal contents leading to acute pulmonary infection is Aspiration pneumonia. It is important to understand and distinguish between aspiration pneumonitis which is an inflammatory process that occurs post-aspiration and aspiration pneumonia for guiding treatment. Since the major complication of this disease syndrome results in ARDS, prompt treatment with supplemental oxygen and antibiotics and measures to prevent further aspiration has to be undertaken. A close monitoring of the patient for hypoxia is mandated and if the present patient should be intubated and mechanically ventilated. In a meta-analysis conducted by Kosaku K et al. it is found that aspiration pneumonia is associated with high-30-day and in-hospital, but outside the intensive care setting, mortality rates in patients with community-acquired pneumonia.


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE courses, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Pneumonia, Aspiration - Questions

Take a quiz of the questions on this article.

Take Quiz
An alcoholic patient presents with foul smelling breath, fevers, and copious secretions. Chest x-ray reveals an air fluid level. The patient can only lie down on his side (laterally). In this position, which part of the lung segment is most likely affected?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which is true of aspiration pneumonia?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following surgical procedures is not used to prevent aspiration?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is of no benefit for a patient who has just aspirated during induction of anesthesia?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A male having a myocardial infarction requires emergent endotracheal intubation. During intubation the patient has massive amount of aspiration and develops a pneumonia. Which should be administered to ensure proper antibiotic coverage for anaerobes?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
An otherwise healthy 45-year-old alcoholic male presents with fever, chills, and cough. Chest x-ray reveals a right lower lobe opacity with an air-fluid level. What is the most likely bacterial pathogen?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
In what position should a patient be placed after a left lung collapse secondary to aspiration?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
When an individual aspirates in the erect position, what lobe of the lung is most commonly affected?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
In a supine position, aspiration will most likely affect which lobe of the lung?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is a risk factor for aspiration during intubation?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
After a barium swallow study, general anesthesia should be delayed because of risk for which of the following?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which is not a usual risk factor for aspiration pneumonitis?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is the best way to decrease the risk of aspiration pneumonitis in a parturient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following has contributed to reducing aspiration pneumonitis as an anesthetic-related cause of death?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following features is NOT seen in aspiration pneumonitis?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Why are alcoholics susceptible to pneumonia?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A male has a myocardial infarction and requires emergent endotracheal intubation. The provider intubates the patient and notices a massive amount of aspiration during the procedure. What should be administered to ensure proper antibiotic coverage?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following organisms is a common cause of community-acquired aspiration pneumonia?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following clinical situations requires antibiotic treatment of an aspiration pneumonitis?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following procedures increase the risk of aspiration pneumonia?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following findings would not indicate aspiration?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 2-week old neonate chokes and gags during feedings and is admitted for pneumonia. Select the appropriate study.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 4-year-old child with cerebral palsy and cognitive development of a 9-month-old is brought in with a fever and a cough. According to the parents, she drools all the time, has chronic hoarseness, and has had 3 episodes of pneumonia. The child is very thin. Exam shows temperature of 38.9 degrees Celsius, pulse of 120 bpm, respirations of 38, and pulse oximetry on room air of 86 percent. There are bilateral course breath sounds, intercostal retractions, and a hoarse voice. Select the appropriate diagnostic study.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 4-year-old child with cerebral palsy and cognitive development of a 9-month-old is brought in with a fever and a cough. According to the parents, she drools all the time, has chronic hoarseness, and has had 3 episodes of pneumonia. The child is very thin. Exam shows temperature of 38.9 degrees Celsius, pulse of 120 bpm, respirations of 38, and pulse oximetry on room air of 86 percent. There are bilateral course breath sounds, intercostal retractions, and a hoarse voice. What should be the initial therapy?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 4-year-old child with cerebral palsy and cognitive development of a 9-month-old is brought in with a fever and a cough. According to the parents, she drools all the time, has chronic hoarseness, and has had 3 episodes of pneumonia. The child is very thin. Exam shows temperature of 38.9 degrees Celsius, pulse of 120 bpm, respirations of 38, and pulse oximetry on room air of 86 percent. There are bilateral coarse breath sounds, intercostal retractions, and a hoarse voice. Chest X-ray shows a left lower lobe infiltrate. Oxygen is started. What is the next step in management?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 4-year-old child with cerebral palsy and cognitive development of a 9-month-old is brought in with a fever and a cough. According to the parents, she drools all the time, has chronic hoarseness, and has had 3 episodes of pneumonia. The child is very thin. Exam shows temperature of 38.9 degrees Celsius, pulse of 120 bpm, respirations of 38, and pulse oximetry on room air of 86 percent. There are bilateral course breath sounds, intercostal retractions, and a hoarse voice. The patient initially has a left lower lobe infiltrate but a chest X-ray the next day shows bilateral upper and lower lobe infiltrates. All cultures are negative, but the tracheal aspirate shows lipid-laden macrophages. What is the most likely diagnosis?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which lung segment is mostly associated with aspiration in erect position?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which lung segment is most associated with aspiration in supine position?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 70-year-old female was found unresponsive on the floor in her apartment. During a phone conversation 2 days ago with her daughter, her voice was hoarse and she had reported myalgias. According to her daughter, she is allergic to penicillin, has recurrent methicillin-resistant Staphylococcus aureus skin infections, and consumes alcohol on a regular basis. Two weeks ago she returned from a cruise trip to the Bahamas. Emergency services noted vomitus soiling the floor adjacent to her and she was intubated for airway protection. In the emergency department, her temperature was 39 C, heart rate 105 beats/min, blood pressure 90/50 mmHg, oxygen saturation 96% on FiO2 70%, pressure support mode ventilation with PEEP 10, pressure support 14 with spontaneous rate 28/min and minute ventilation 10 L/min. Blood alcohol level was 155 mg/dL, white cell count 24,000/microliter, serum creatinine 2 mg/dL, and serum sodium 130 mg/dL. Liver functions were normal. A chest x-ray confirmed correct placement of endotracheal tube and a dense right lower lobe infiltrate. CT of the brain was normal and cerebrospinal fluid analysis demonstrated no white cells and normal glucose and protein. Blood cultures were sent, intravenous vancomycin 1000 mg and levofloxacin 500 mg were given in the emergency department. The patient was transferred to the medical intensive care unit. Which of the following changes to her antibiotic regimen would be most appropriate?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
In aspiration pneumonia, the most irritating lipid is:



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 40-year-old male requires a gastric sleeve resection for weight loss. The induction with ketamine is uneventful but just at the time of insertion of the endotracheal tube, the patient aspirates. Which of the following will be of no benefit for this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 56-year-old male is brought to the emergency department after EMS found him unresponsive on the roadside. In the emergency department, he appears lethargic and his breath smells of alcohol. His vital signs show blood pressure 110/90 mmHg, heart rate 94 bpm, respiratory rate 26/min, temperature 100.9 F, and SpO2 89% on room air. On examination, he appears disheveled, drowsy, only responds to painful stimulus, has rapid shallow breaths, and bilateral crackles are heard on lung exam. His CBC shows WBC 17,000/microL with a left shift, hemoglobin 10.2 g/dl and hematocrit 30.6%. Electrolytes and renal function are normal. His serum alcohol level is 15400 mg/dL. Chest x-ray shows bilateral small pleural effusion and ground glass opacification in the right lower lobe. He is given thiamine and folate and is started on normal saline. What is the next step in the management of this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 75-year-old male is admitted to the regular medicine floor for newly diagnosed right middle cerebral artery stroke. His past medical history is significant for hypertension, diabetes mellitus, hyperlipidemia and benign prostatic hyperplasia. He is started on aspirin and clopidogrel. His neurological exam was significant for left-sided weakness with difficulty in swallowing. A speech and swallow eval revealed that he is unable to consume solids or clear liquid food yet. He was started on thick nectar liquid food. On the fourth day of hospitalization, he was found to be more lethargic and having shortness of breath. He spiked a fever of 100.6F. His vitals at the time of exam was BP: 110/90mm of Hg RR: 28 bpm HR: 98 bpm SpO2: 98% on room air. Physical exam was positive for left-sided weakness, and lung exam showed bilateral crackles and reduced breath sounds in the right mid lung zones. A repeat CT scan of the head was normal. Apart from obtaining a chest x-ray which of the following is next best step in this patient's management?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Pneumonia, Aspiration - References

References

Pneumonitis and pneumonia after aspiration., Son YG,Shin J,Ryu HG,, Journal of dental anesthesia and pain medicine, 2017 Mar     [PubMed]
Risk factors for aspiration in community-acquired pneumonia: analysis of a hospitalized UK cohort., Taylor JK,Fleming GB,Singanayagam A,Hill AT,Chalmers JD,, The American journal of medicine, 2013 Nov     [PubMed]
Pulmonary aspiration syndromes., Marik PE,, Current opinion in pulmonary medicine, 2011 May     [PubMed]
Aspiration pneumonitis and aspiration pneumonia., Marik PE,, The New England journal of medicine, 2001 Mar 1     [PubMed]
Microbiology of severe aspiration pneumonia in institutionalized elderly., El-Solh AA,Pietrantoni C,Bhat A,Aquilina AT,Okada M,Grover V,Gifford N,, American journal of respiratory and critical care medicine, 2003 Jun 15     [PubMed]
Prognostic implications of aspiration pneumonia in patients with community acquired pneumonia: A systematic review with meta-analysis., Komiya K,Rubin BK,Kadota JI,Mukae H,Akaba T,Moro H,Aoki N,Tsukada H,Noguchi S,Shime N,Takahashi O,Kohno S,, Scientific reports, 2016 Dec 7     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of Nurse-Professional and Ethics. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for Nurse-Professional and Ethics, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in Nurse-Professional and Ethics, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of Nurse-Professional and Ethics. When it is time for the Nurse-Professional and Ethics board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study Nurse-Professional and Ethics.