Pulmonary aspiration

Three of five men, who lost consciousness within a few minutes of entering a partially drained underground liquid manure storage tank, died before reaching the hospital autopsy showed that two had massive liquid manure pulmonary aspiration, while the third had fulminant pulmonary edema without manure aspiration (Osbem and Crapo 1981). Markedly elevated heart-blood sulfide-ion levels indicated significant hydrogen sulfide exposure. Air samples analyzed about a week after the accident detected only 76 ppm of hydrogen sulfide, but the study authors noted that the environmental conditions were probably different (e g., warmer weather, less-concentrated manure). 

Toxicology. Fuel oils cause gastrointestinal irritation, pulmonary aspiration pneumonia, neurological effects and can be irritants of the skin and eyes. 

Light Vacuum Gas Oil CAS number Classification Hazard class TSCA Safety profile 64741-58-8 Flammable Liquid 3 Reported in inventory Possible carcinogen pulmonary aspiration can cause severe pneumonitis. 

Like other aluminium salts, pulmonary aspiration of sucralfate can lead to acute lung injury. There is some systemic absorption of aluminium, which is probably significant only in patients with renal impairment. Administration can be associated with a degree of hypophosphataemia, and there is also interference with absorption of some other drugs, e.g. quinolone antibacterials, digoxin, quinidine, and warfarin. 

Seizures induced by local anesthetics are usually treated with intravenous anesthetic drugs (eg, thiopental 1-2 mg/kg, propofol 0.5-1 mg/kg, midazolam 0.03-0.06 mg/kg). The muscular manifestations of a seizure can be blocked using a short-acting neuromuscular relaxant drug (eg, succinylcholine, 0.25-0.5 mg/kg IV). It should be emphasized that succinylcholine does not alter the CNS manifestations of local anesthetic-induced seizure activity. Rapid tracheal intubation can prevent pulmonary aspiration of gastric contents and facilitate hyperventilation. 

Seizures, muscular hyperactivity, and rigidity may result in death. Seizures may cause pulmonary aspiration, hypoxia, and brain damage. Hyperthermia may result from sustained muscular hyperactivity and can lead to muscle breakdown and myoglobinuria, renal failure, lactic acidosis, and hyperkalemia. Drugs and poisons that often cause seizures include... 

Laboratory personnel are another category of health care provider who will need increased attentiveness to unusual patterns. They are in a position to detect changes in the number of culture requests or an increase in uncommon specimen types such as pulmonary aspirates (CDC, 2001c). In addition, laboratory records of culture patterns may show increases in unusual strains, or strains with resistance patterns not usually seen in a given facility or locality (USAMRllD, 2005 USDHHS, 2001). 

SAFETY PROFILE Confirmed carcinogen with experimental carcinogenic data. Pulmonary aspiration can cause severe pneumonitis. A flammable liquid. When heated to decomposition it emits acrid smoke and irritating fumes. 

Usually intravenous pre-oxygenation followed by a small dose of an opioid, e.g., fentanyl or alfentanil to provide analgesia and sedation, followed by propofol or, less commonly, thiopental or etomidate to induce anaesthesia. Airway patency is maintained with an oral airway and face-mask, a laryngeal mask airway (LMA), or a tracheal tube. Insertion of a tracheal tube usually requires paralysis with a neuromuscular blocker and is undertaken if there is a risk of pulmonary aspiration from regurgitated gastric contents or from blood. 

Pulmonary aspiration is an ever-present risk of using charcoal, especially in semi-conscious patients (2). Povidone, which is nsed as a snspending agent of charcoal, can cause pneumonitis, which can lead to respiratory failure and death. 

Menzies DG, Busuttil A, Prescott LF. Fatal pulmonary aspiration of oral activated charcoal. BMJ 1988 297(6646) 459-60. 

Chan TY, Critchley JA. Pulmonary aspiration following Dettol poisoning the scope for prevention. Hum Exp Toxicol 1996 15(10) 843-6. 

Loss of the gastric acid barrier can predispose to intestinal infection, and pulmonary aspiration of infected gastrointestinal secretions can very occasionally cause pneumonia after anesthesia or during intensive care (2). Interstitial lung disease can occur under these conditions. 

Musich J, Walts LF. Pulmonary aspiration after a priming dose of vecuronium. Anesthesiology 1986 64(4) 517-19. 

Basic and advanced life-support measures should be implemented as necessary. Gastrointestinal decontamination procedures should be used as appropriate based on the patient s level of consciousness and history of ingestion. Activated charcoal can be used to adsorb the benzodiazepines. The patient s level of consciousness and vital signs should be monitored closely. Obtunded patients with reduced gag reflex should be intubated to prevent pulmonary aspiration. Respiratory support, including oxygen and ventilation, should be provided as needed. If hypotension occurs it should be treated with standard... 

No acute effects have been reported in humans. By analogy to effects reported with structurally similar compounds and in animals, cyclohexene is regarded as a mild respiratory irritant and CNS depressant. When ingested, it represents a low to moderate pulmonary aspiration hazard. 

Persons who are exposed to high concentrations of decane in air should vacate or be removed from the source and seek fresh air. Upon oral ingestion, vomiting should not be induced as pulmonary aspiration may occur, resulting in severe narcosis and/or death. In areas of expected increased concentration, extreme... 

If vomiting occurs, pulmonary aspiration should be watched for. In cases of respiratory compromise, airway and respiration should be secured via endotracheal entubation. Patients who have bronchospasm should be treated with aerosolized bronchodilators. Epinephrine or related substances should not be administered. There is no antidote for gasoline. Treatment should support respiratory and cardiovascular functions. 

Gastric emptying by either lavage or vomiting is contraindicated since there is a danger of pulmonary aspiration and subsequent pneumonitis. If a person is overexposed to oil mist, the victim should be moved to fresh air as quickly as possible and monitored to make sure that chemical pneumonitis is not present. If acute effects of central nervous system depression are present, the appropriate treatment may be indicated. 

Charcoal is generally very safe and few adverse effects from the use of single dose activated charcoal have been reported despite its widespread use. There are no reports of gastrointestinal obstruction associated with single dose activated charcoal. The most common complications of charcoal administration include constipation, diarrhea, and vomiting. Pulmonary aspiration of activated charcoal is a dreaded complication that can result in pneumonitis, obstruction of the respiratory tree, and bronchiolitis obliterans. Aspiration of large amounts of charcoal can be fatal. 

Because of the risk of pulmonary aspiration due to respiratory arrest, seizures, or vomiting, emergency department staff should not induce emesis. Instead, if the patient is alert and has not received charcoal previously, the patient should receive a slurry of activated charcoal. Gastric lavage, if administered within 30 min or less after ingestion, may be helpful. Staff attending to patients should consider gastric contents hazardous, and should dispose them appropriately (9). 

Monitor for complications of pulmonary aspiration such as hypoxia and pneumonia by physical findings and chest radiographs... 

Patients with coexisting cardiovascular and pulmonary conditions (e.g., ARDS, pulmonary infection, pulmonary aspiration) may be more susceptible to the toxic effects or complications of tricyclic antidepressant poisoning. The influence of chronic exposure to tricyclic antidepressants on the risks of an acute overdose is unclear. Tricyclic antidepressants interact with other central nervous system depressant drugs, which together may lead to increased central nervous system and respiratory depression. 

Aspiration pneumonitis—The inflammation of lung tissue caused by the aspiration of fluids and gastric contents that often leads to dyspnea, pulmonary edema, secondary infections and adult respiratory distress s5mdrome. Hydrocarbon pneumonitis is caused by the pulmonary aspiration of hydrocarbons such as kerosene and gasoline. 

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