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Dysphagia and Aspiration
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Prevention of aspiration occurs primarily through reflex laryngeal closure, laryngeal elevation, and cessation of breathing during swallowing, and any aspirated contents are expelled through coughing. A certain amount of aspiration is normal in humans, especially during sleep, and it is tolerated without complications in healthy subjects with normal tracheobronchial ciliary function and normal immunology.
Care
Published in Henry J. Woodford, Essential Geriatrics, 2022
The potential consequences of reduced swallow ability include malnutrition and difficulties taking oral medication. Aspiration is a term for food, drink, or saliva entering the airways, which can lead to aspiration pneumonia (see page 400). Aspiration usually provokes a cough but can occur without any obvious symptoms or signs, termed ‘silent aspiration'. A reduction in cough force can reduce the ability to clear airways of aspirated matter. Signs indicative of swallowing problems include pooling of food in the mouth, coughing or choking when eating, wet voice quality after eating, or recurrent chest infections.
Obstruction of the Respiratory Orifices, Larynx, Trachea and Bronchia
Published in Burkhard Madea, Asphyxiation, Suffocation,and Neck Pressure Deaths, 2020
These occur in cases of chyme and blood aspiration (Figures 21.4 and 21.5). If large quantities of acidic gastric juices are aspirated when vomiting chyme, brownish grey areas of preliminary digestion may form on the tissue of the lungs (Mendelson's syndrome). Furthermore, many cases exhibit a pronounced pulmonary oedema. Where this does not prove fatal, aspiration pneumonia subsequently develops. Postmortem CT imaging may be helpful in assessing the severity of aspiration [9,10].
Status epilepticus in pregnancy: a literature review and a protocol proposal
Published in Expert Review of Neurotherapeutics, 2022
Roberta Roberti, Morena Rocca, Luigi Francesco Iannone, Sara Gasparini, Angelo Pascarella, Sabrina Neri, Vittoria Cianci, Leonilda Bilo, Emilio Russo, Paola Quaresima, Umberto Aguglia, Costantino Di Carlo, Edoardo Ferlazzo
Supportive care (airway patency, ensuring oxygenation, and avoiding aspiration) should be given.BDZs (lorazepam, midazolam or diazepam) bolus are the drugs of choice for initial SE management.If SE persist, LEV or PHT (or pPHT) bolus are suggested.VPA may be useful if the above mentioned ASMs fail, preferably in the second or third trimester.If SE persist, IVADs are needed, with propofol and midazolam as preferred drugs.Termination of pregnancy, via delivery or abortion, is recommended if the prolonged exposure to multiple drugs fail and after a care risk-benefit balance for both mother and fetus.
Dysphagia and medicine regimes in patients following lung transplant surgery: A retrospective review
Published in International Journal of Speech-Language Pathology, 2021
Anna Miles, Sujay Barua, Naomi McLellan, Lejla Brkic
Consequences of aspiration to the new allograft lung in this immune suppressed population are potentially severe. Despite this, little is known about the prevalence, risk factors, extent, trajectory and longevity of pharyngeal dysphagia (a common cause of aspiration) to guide multi-disciplinary management. A recent systematic review identified only five studies investigating pharyngeal dysphagia and/or dysphonia after lung transplant (Black et al., 2020). The authors were unable to determine prevalence due to the low quality and heterogeneous nature of studies. Possible causes of pharyngeal dysphagia include prolonged intubation times and hypothermic ice injury as well as risks from the proximity of the surgery to the laryngeal, pharyngeal and oesophageal nerves, all increasing the likelihood of pharyngo-laryngo-oesophageal impairments (Black et al., 2020; Davis et al., 2010). There was little substantial evidence regarding prognosis or duration of dysphagia, and no pre-lung transplant investigations to assess pre-existing swallowing difficulties. Black and colleagues concluded that high rates of pharyngeal dysphagia were likely post-lung transplant with a high rate of silent aspiration but that greater understanding of this population was needed (Black et al., 2020).
A foreign body in the mediastinum as a cause of chronic cough in a 10-year-old child with asthma
Published in Journal of Asthma, 2021
Ewa Łoś-Rycharska, Zuzanna Wasielewska, Katarzyna Nadolska, Aneta Krogulska
Foreign bodies are most commonly aspirated into the respiratory tract by small children and are usually fragments of toys or food (12,13). Usually they enter the trachea or bronchi through the mouth or nose, leading to the development of clinical symptoms of varying intensity. It is initially characterized by a period of sudden, short fit of coughing or repeated attacks. This is followed by a oligosymptomatic period lasting a few days. Later, acute bacterial inflammatory complications of the bronchi and lungs are typically observed. Almost 80% of these children are admitted to hospital due to acute symptoms within 24 h following the aspiration incident (14,15). Only 15% are correctly diagnosed within the first seven days after choking (10). The period from initial aspiration to diagnosis can range from four to 12 months (16–19). It is possible that the presence of foreign bodies in the trachea or bronchi may not elicit any symptoms, especially in children, and some foreign bodies, such as needles, pins or wires, can remain undetected in the bronchi for long periods. Although the most common symptom is coughing, recorded in 74% of children diagnosed with aspiration of a foreign body (14,15), the symptoms associated with aspiration or ingestion can simulate other pediatric diseases such as asthma, croup or pneumonia; this can delay the correct diagnosis (10). It is possible that the present diagnosis may have been established earlier if the boy had not previously been diagnosed with asthma.