Sammy, age 3 years, ate his dinner and then said his tummy hurt. His mother suggested he lie down in the adjacent room while his parents finished dinner. A few minutes later, they heard Sammy vomiting. His mother rushed in to lift Sammy up. When vomiting ceased, they noticed Sammy continued to cough and seemed to be choking. He was struggling to breathe and a wheezing sound was obvious. It appeared that he had aspirated some vomitus. His parents drove him to a nearby hospital for examination.

 

Discussion Questions

1. Discuss the specific effects of aspirating vomitus on Sammy, including the probable effects on his bronchi and lungs. Why might one lung be affected more than the other?
2. Discuss the pathophysiologic changes causing the signs and symptoms and any tests required to clarify the effects on Sammy.
3. Suggest some reasons for Sammy's difficulty breathing and wheezing.
4. Discuss the potential complications of aspiration of vomitus.

 

Answer:

1. Aspirating vomitus after taking dinner causes mechanical airway blockage. Sammy's lungs are affected because the content of the vomitus damages the lung parenchyma and tracheo-bronchial tree resulting in inflammation. The bronchi are also corroded from the acidic stomach contents that could be loaded with micro-bacterial loads. One lung can be more affected because the child was lying down on one side and the vomitus was aspirated to the most proximal lung more.
2. The pathophysiologic changes after the aspiration results from mechanical blockage and secondary infection. Once the vomitus is aspirated into the lungs there is chemical burns because of the low pH contents. The destruction of alveolar endothelial capillary cells facilitates the outpouring of protein rich fluid into the interstitial and intra-alveoli spaces. The result is therefore collapse of alveoli and pulmonary edema. Once the dead space volume increases owing to the decreased functional alveoli, the baby cannot breath efficiently causing wheezing. Coughing is evident as the body tries to get rid of the vomitus out of the lungs.the potential tests taken include chest x-ray and lung sounds such as crackles
3. The reasons for difficulty in breathing and wheezing include mechanical blockage,collapse of alveoli and damaged airways
4. Aspiration of vomitus has complications such as aspiration pneumonia,emphysema,acute respiratory distress,bronchitis and even death from hypoxia.

Aspiration pneumonia is caused by aspiration of vomitus causing inflammation in lungs