what would be your 1st intervention for pt aspirating?

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What do you do when your pt who has a h/o CVA new SDH w/high aspiration risk, is aspirating on lunch, coughing, turning bright red, w/hob 90 degrees. anterior LS sound rhonchorous sats 93% ra. What would your first intervention be?

Specializes in NICU.

I guess my brain went a different direction. Not unusual. Ha! Maybe it's because I'm used to babies....but when a baby gags and sputters, I tip them forward a little, or turn them on their side some....maybe both. I would guess the same logic applies to the big people, but maybe not.

All the other stuff is awesome, though...the swallow eval, etc.

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Specializes in Pediatrics, Nursing Education.
What? You don't offer him another drink to wash it down?:lol2:

BAWHAHAHHAHHAA!!!:yeah: Gawd love it!

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Specializes in Pediatrics, Nursing Education.
I dont agree with getting abx yet. You dont routinely start abx just because people are choking. Get a CXR first, and if he's febrile then by all means use abx but you need some positive data that he's really got an infection first, otherwise what are you treating?

In peds, I guess what I have delt with most is fetal aspiration syndrome... not this senario. Of course there are other aspiration senarios in peds that fit more closely to this one... but I haven't had a lot of personal experience with them so thinking of them (like thinking of conditions that would lead to weakness and risk for aspiraton, etc)... in context to this one... I am trying to think of what we did. most of the nursing interventions are dead on for the older kids (like with Duschenne's MD, etc) but I can't remember starting prophylactic antibotics...

But what you said rang true to me... you have to have a problem to treat it, so I don't know about treating prophylactically for choking / aspiration episodes...

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I dont agree with getting abx yet. You dont routinely start abx just because people are choking. Get a CXR first, and if he's febrile then by all means use abx but you need some positive data that he's really got an infection first, otherwise what are you treating?

but you need to distinguish between choking and aspirating.

i'm talking about aspirating, where fluids spill into the lungs.

if it's microaspiration, then it's a wait and see.

but if i feel a healthy amt seeped into the airway, i'll ask the doc about getting started on abx.

to date, i have never had a pt who didn't get aspiration pneumonia.

where i work, we won't get cxrs.

these folks are hospice and are giving abx for comfort.

leslie

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Specializes in Med/Surg, Homecare, UR, Case Mgt.

Would you document "pt aspirating on lunch" or is this inappropriate since no CXR actually confirmed this??? Or would you just document objective observations ie vs, coughing, LS, etc??

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Specializes in Ortho, Case Management, blabla.
What do you do when your pt who has a h/o CVA new SDH w/high aspiration risk, is aspirating on lunch, coughing, turning bright red, w/hob 90 degrees. anterior LS sound rhonchorous sats 93% ra. What would your first intervention be?

Remove lunch plate. heheh

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Specializes in Med-Surg, Psych, Tele, ICU.

Was a swallow study done, either at the bedside or in radiology? My first intervention would be airway.

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Specializes in Med/Surg, Homecare, UR, Case Mgt.
Was a swallow study done, either at the bedside or in radiology? My first intervention would be airway.

Swallow eval was done prior to lunch which found High Risk for aspiration>nectar consistency/pureeed/dypahgia protocol ( 90 degree hob, chin tuck, etc). Modified Barium Swallow was ordered for the am.

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Would you document "pt aspirating on lunch" or is this inappropriate since no CXR actually confirmed this??? Or would you just document objective observations ie vs, coughing, LS, etc??

document objective observations.

as you stated, while we 'know' he aspirated, only cxr would confirm this.

leslie

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Specializes in Pediatrics, Nursing Education.
but you need to distinguish between choking and aspirating.

i'm talking about aspirating, where fluids spill into the lungs.

if it's microaspiration, then it's a wait and see.

but if i feel a healthy amt seeped into the airway, i'll ask the doc about getting started on abx.

to date, i have never had a pt who didn't get aspiration pneumonia.

where i work, we won't get cxrs.

these folks are hospice and are giving abx for comfort.

leslie

oh oh oh

i was reading in my PALS book just yesterday and while again, don't know if it is the same for adults... in peds... in aspiration pneumonia, you treat when you have signs of infection, such as infiltrates and fever. the use of prophylaxis is not recommended.

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oh oh oh

i was reading in my PALS book just yesterday and while again, don't know if it is the same for adults... in peds... in aspiration pneumonia, you treat when you have signs of infection, such as infiltrates and fever. the use of prophylaxis is not recommended.

i don't encourage it for prophylactic use, per se...

i've just seen too many of my pts aspirate, only to become symptomatic within a few hrs.

we have an antibiotic kit and just get the meds from there.

if they didn't develop symptoms, we wouldn't continue with them.

but since all of our pts have became febrile and junky, we end up ordering a week's worth of the ordered med.

jeepgirl, you crack me up (oh oh oh)

the visuals made me laugh.:)

leslie

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Specializes in Pediatrics, Nursing Education.
i don't encourage it for prophylactic use, per se...

i've just seen too many of my pts aspirate, only to become symptomatic within a few hrs.

we have an antibiotic kit and just get the meds from there.

if they didn't develop symptoms, we wouldn't continue with them.

but since all of our pts have became febrile and junky, we end up ordering a week's worth of the ordered med.

jeepgirl, you crack me up (oh oh oh)

the visuals made me laugh.:)

leslie

i was, i was wiggling in my chair!!!

and i totally believe you. i bet most of them become symptomatic within just a little while and end up needing big guns.

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