Aspiration of gastric contents

Signs
Gastric contents in the oropharynx, severe hypoxemia, increased airway pressures, bronchospasm, copious tracheal secretions, coughing, laryngospasm, rhonchi, dyspnea, hyperventilation.

Treatment
Tracheal suctioning prior to positive pressure ventilation.
Trendelenberg, right lateral tilt.
Ventilation 100% FiO2, PEEP.
Bronchoscopy, lavage, suction.
Cancel elective surgery.
ICU ventilator.
Antibiotics based on gram stain.
Bronchodilators.
Steroids (no proven benefit).
ECMO.
Lung Transplant.

Lab
Lavage sample for pH, Gram stain, and culture.
Chest x-ray.

ASPIRATION PROPHYLAXIS
Guidelines
Metoclopramide reduces gastric volume. Does not decrease risk of aspiration in healthy patients.
H2 blockers (cimetidine, famotidine, ranitidine, nizatadine) and proton pump inhibitors reduce gastric acidity and volume. Do not decrease risk of aspiration in healthy patients.
Antacids decrease gastric acidity. Do not decrease risk of aspiration in healthy patients.