CPR Renewal
Online Training
New NRP Class
Aspiration Pneumonia – Purpose
May 15, 2009
PURPOSE:
To educate healthcare professionals about the risks, symptoms, complications and treatment of aspiration pneumonia.
Aspiration Pneumonia – Objectives
May 15, 2009
OBJECTIVES:
Upon completion of this program the learner will be able to:
- Distinguish between aspiration pneumonitis and aspiration pneumonia
- List 2 causative organisms of community-acquired aspiration pneumonia
- List 5 risk factors for aspiration pneumonia
- List 4 symptoms of aspiration pneumonia
- Identify 6 tests used to diagnose aspiration pneumonia
- List 3 complications of aspiration pneumonia
- Discuss 3 methods of prevention of this disease
Aspiration Pneumonia – References
May 15, 2009
REFERENCES
Akritidis, N., Gousis, C., Dimos, G: Fever, cough, and bilateral lung infiltrates. Achalasia associated with aspiration pneumonia. Chest 2003 Feb; 123(2): 608-12.
Bartlett, J.G. Pneumonia: Management of respiratory tract infections, 2nd ed. (1999) Lippincott Williams & Wilkins, Philadelphia, PA.
Campbell, G.D., Niederman, M.S., Broughton, W.A., et al. Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. A consensus statement. American Thoracic Society, November 1995. Am J Respir Crit Care Med 1996;153(5):1711-25.
Drakulovic, M.B., Torres, A., Bauer, T.T., et al: Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 1999 Nov 27; 354(9193): 1851-8.
Ferri, F.F. Ferri’s Clinical Advisor (2007), 1st ed. Mosby, Philadelphia, PA..
Goldman, L., Ausiello, D. Cecil Textbook of Medicine, 22nd ed. (2003). Saunders, Philadelphia, PA.
Marik, P.E., Careau, P: The role of anaerobes in patients with ventilator-associated pneumonia and aspiration pneumonia: a prospective study. Chest 1999 Jan; 115(1): 178-83.
Marik, P.E. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med 2001;344(9):665-71.
Marom, E.M., McAdams, H.P., Erasmus, J.J: The many faces of pulmonary aspiration. AJR Am J Roentgenol 1999 Jan; 172(1): 121-8.
Marx, J.S., Hockberger, R.S., Walls, R.M., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice, 5th ed. (2002). Mosby, St. Louis, MO.
Russell, S.L., Boylan, R.J., Kaslick, R.S., et al. Respiratory pathogen colonization of the dental plaque of institutionalized elders. Spec Care Dentist 1999;19(3):128-34.
Sasaki, H., Sekizawa, K., Yanai, M: New strategies for aspiration pneumonia. Intern Med 1997 Dec; 36(12): 851-5.
Aspiration Pneumonia – Outline
May 15, 2009
OUTLINE
I. Definition
II. Aspiration Pneumonitis
III. Aspiration Pneumonia
IV. Causative Organisms
V. Risk Factors
VI. Frequency
VII. Mortality/Morbidity
VIII. Symptoms
IX. Diagnosis
X. Physical Examination
XI. Signs and Tests
XII. Lab Studies
XIII. Imaging Studies
XIV. Treatment
XV. Pre-hospital Care
XVI. Emergency Department Care
XVII. Consultations
XVIII. Complications
XIX. Prognosis
XX. Prevention
XXI. Summary
XXII. References
Pandemic Influenza – 1 Contact Hour
May 11, 2009
What Is Pandemic Influenza?
An influenza pandemic is an influenza epidemic that spreads on a worldwide scale, infecting a large proportion of the human population. In contrast to regular seasonal epidemics of influenza, these pandemics occur irregularly, with the 1918 Spanish flu the most serious pandemic in recent history. Three influenza pandemics occurred in the 20th century and killed tens of millions of people, with each of these pandemics being caused by the appearance of a new strain of the virus in humans. Often, these new strains result from the spread of an existing flu virus to humans from other animal species. History teaches that the influenza virus mutates to cause a worldwide epidemic about twice a century, on average. But scientists have yet to figure out what causes these viral mutations, when they will occur and what makes certain viruses more lethal than others.
Seasonal Influenza
Influenza, commonly referred to as the flu, is an infectious disease caused by RNA viruses of the family Orthomyxoviridae, which affects birds and mammals. The name influenza comes from the Italian, meaning “influence”. The most common
symptoms of the disease are chills, fever, pharyngitis, muscle pains, severe headache, coughing, weakness and general discomfort. In more serious cases, influenza causes pneumonia, which can be fatal, particularly for the young and the elderly. In children the immune responses are still developing, while the elderly immune function tends to be weaker due to the aging process. Influenza, although often confused with the common cold, is a much more severe disease and is caused by a different type of virus.
Most people who get the flu recover completely in one to two weeks, but some people develop serious and potentially life-threatening medical complications, such as pneumonia. In an average year, influenza kills an estimated 250,000 to 500,000 people worldwide, with about 36,000 deaths in the United States and many more hospitalizations. Flu-related complications can occur at any age; however, the elderly and those with chronic health problems are much more likely to develop serious complications. By contrast, pandemic flus often strike young, healthy people the hardest.
Modes of Transmission
Influenza can be highly contagious, particularly among persons without pre-existing antibodies against influenza, such as young children during the inter-pandemic phase and anyone during a pandemic. Roughly 50% of all infections are, however, asymptomatic. Asymptomatic infection is especially common in children. The influenza virus is transmitted in most cases by droplets through the coughing and sneezing of infected persons, but it can be transmitted by direct contact as well.
Direct Contact
Direct-contact transmission involves skin-to-skin contact and physical transfer of microorganisms to a susceptible host from an infected or colonized person, such as occurs when healthcare personnel turn patients, bathe patients, or perform 
other patient-care activities that require physical contact. Direct-contact transmission can also occur between two patients (e.g., by hand contact), with one serving as the source of infectious microorganisms and the other as a susceptible host. Indirect-contact transmission involves contact of a susceptible host with a contaminated intermediate object, usually inanimate, in the patient’s environment (such as needles or countertops).
Droplet
Droplet transmission occurs when contagious droplets produced by the infected host are propelled a short distance through coughing or sneezing and can come into contact with another person’s conjunctiva, mouth or nasal mucosa. Influenza can be transmitted by large droplets, which generally travel 3 to 6 feet. Since these droplets are generally greater than 10 micrometers and do not stay suspended in the air, this mode of transmission is not affected by special air handling or control of room pressures. Large droplets appear to be the primary route of nosocomial transmission.
Airborne (Droplet Nuclei)
Droplet nuclei (airborne) transmission entails the production of infectious droplet nuclei, generally 5 micrometers or less in diameter. In contrast with larger droplets, these droplets can remain suspended in the air and be disseminated by air currents in a room or through a facility, to be inhaled by a susceptible host. Small droplet nuclei and aerosols can remain suspended in the air for prolonged periods and travel significant distances. Small particles appear to be more infectious, with both the degree of infectivity and the severity of illness directly related to particle size. Aerosols smaller than 10 microns have been shown to cause more severe disease and require a smaller inoculum than large intranasal droplets. Preventing the spread of droplet nuclei requires the use of special air handling and ventilation procedures.
There is no evidence that influenza transmission can occur across long distances (e.g., through ventilation systems) or through prolonged residence in air, as seen with airborne diseases such as tuberculosis. Organisms transmitted in this manner must be capable of sustaining infectivity, despite desiccation and environmental variation that generally limit survival in the airborne state. However, transmission may occur at shorter distances through inhalation of small-particle aerosols (droplet nuclei), particularly in shared air spaces with poor air circulation. An experimental study involving human volunteers found that illness could be induced with substantially lower virus titers when influenza virus was administered as a small droplet aerosol rather than as nasal droplets, suggesting that infection is most efficiently induced when virus is deposited in the lower rather than the upper respiratory tract.
Evidence supporting the relative contribution of each route of transmission for influenza is limited; however, droplet transmission is thought to be the predominant form of spread in a setting with an appropriate number of air exchanges and standard ventilation. In the absence of appropriate ventilation and air exchange, airborne transmission may play a greater role, such as in a crowded space where air exchange is limited.
