What is the management for a patient who aspirated a tablet (medication)?

From the Guidelines

Management of a patient who has aspirated a tablet requires prompt intervention to prevent complications, and the most effective strategy is to encourage the patient to cough forcefully to expel the tablet, followed by the Heimlich maneuver for conscious patients or CPR with chest compressions for unconscious patients, as recommended by recent guidelines 1. The initial steps in managing a patient who has aspirated a tablet include:

• Encouraging the patient to cough forcefully to expel the tablet
• Performing the Heimlich maneuver for conscious patients or beginning CPR with chest compressions for unconscious patients
• Seeking immediate medical attention as the patient may need bronchoscopy for tablet removal In a healthcare setting, supplemental oxygen should be provided to maintain oxygen saturation above 94%, and continuous monitoring of vital signs is essential, as noted in a study on preventing healthcare-associated pneumonia 1. If the tablet has dissolved and caused chemical pneumonitis, treatment may include:
• Bronchodilators like albuterol (2.5 mg via nebulizer every 4-6 hours)
• Corticosteroids such as methylprednisolone (1-2 mg/kg/day IV)
• Antibiotics if secondary infection develops, as discussed in a guideline on the early management of patients with acute ischemic stroke 1 Chest physiotherapy and adequate hydration are also important supportive measures, and the severity of complications depends on the tablet's composition, with some medications causing more severe chemical irritation than others, as highlighted in a comprehensive overview of nursing and interdisciplinary care of the acute ischemic stroke patient 1. Long-term follow-up may be necessary to monitor for bronchial stenosis or other complications, particularly if the aspiration caused significant inflammation or tissue damage, and strategies to reduce aspiration, such as elevation of the head of the bed and post-pyloric feeding, should be considered, as recommended in a guideline on home enteral nutrition 1.

From the Research

Management of Aspirated Tablet

The management of a patient who has aspirated a tablet (medication) involves several key steps to ensure the best possible outcome.

• Establishment of a patent airway and maintenance of adequate oxygenation are the initial requirements for successful treatment of all types of aspiration emergencies 2.
• The nature of the aspirated material dictates further interventions and potential outcome 2.
• If the aspirated material is an iron pill, bronchoscopic removal may be necessary to prevent cytotoxic damage from local free-radical generation, which can result in airway damage 3.
• In patients at risk for aspiration, rapid sequence induction and intubation (RSI) should be performed with optimal drug pre-treatment, such as antacids, proton pump inhibitors, or H2 blockers, and with careful consideration of the patient's medical history and current condition 4.
• Treatment of aspiration pneumonitis should focus on aggressive pulmonary care to enhance lung volume and clear secretions, with intubation used selectively and early corticosteroids and prophylactic antibiotics not indicated 5.
• Treatment of aspiration pneumonia requires diligent surveillance for clinical signs of pneumonia, with treatment decisions based on clinical diagnostic certainty, time of onset, and host factors 5.

Key Interventions

• Head down in right lateral position to drain vomit from airway
• Suction
• Laryngoscopy to clear the airway
• Bronchoscophy if asphyxiated by solid material
• Endotracheal intubation if liquid
• High inspired oxygen
• Artificial ventilation if the PO2 is low
• Steroids, such as Hydrocortisone or Dexamethasone, may be administered to reduce inflammation 6.
• Aminophylline may be used to treat severe bronchospasm 6.
• Plasma or plasma substitute may be administered to correct hypotension and hypovolaemia 6.
• Correction of acidosis is also an important aspect of treatment 6.

Considerations for Anesthesia

• Expertise and competence of the physician before and during rapid sequence induction and intubation can minimize the risk of aspiration 4.
• Adequate equipment and optimized upper body elevation of the patient can also reduce the risk of aspiration 4.
• Consistent pre-oxygenation with an FIO2 of 1.0 and an oxygen flow > 10 l/min using a completely sealing respiratory mask with capnography should take 3-5 minutes 4.
• A combination of opioid, hypnotic, and muscle relaxation can achieve fast enough deep anesthesia and muscle relaxation to avoid coughing and choking 4.