Aspiration Pneumonitis

-- Acute onset dyspnea, hypoxia, cough (hrs after event), ± wheeze

• Sx: fever, productive cough, dyspnea, fatigue, AMS

• DENIES: chest pain, Fever, chills, purulent sputum, pleuritic CP (early)

• pertinent SHx: EtOH/drug use, recent vomiting, sedation/anesthesia, dysphagia, dementia, seizure, GERD

• pertinent DATA : Hypoxia (↓SpO₂), CXR: dependent infiltrates, labs often normal early (WBC may be nl)

• pertinent Micro form past:

• (NO Prior respiratory MRSA/Pseudomonas colonization, Recent hospitalization and IV antibiotics (≤ 90 days) )

• pertinent meds: Sedatives (benzos, opioids), anticholinergics, PPIs, neuro/psych meds

• DDX: Aspiration pneumonia, CAP, atelectasis, ARDS, PE

• Aspiration risk factors include dementia or altered mental status, alcohol or drug use, dysphagia (e.g., stroke), GERD, poor dentition, seizure, impaired gag reflex, and being bedridden.

Plan

• Supportive ONLY initially (O₂, airway support, suction)

• NO antibiotics upfront

• Reassess in 24–48h If worsening or signs of infection → treat as pneumonia

• trend CBC,RFP, and fever curve