Aspiration and regurgitation

Your progress

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Target exams

Red flags

• Mendelson pneumonitis is chemical injury — suction, oxygenate, protective ventilation; no routine lavage, no prophylactic antibiotics, no steroids as standard care.
• Risk stack: non-fasted, obstruction/ileus, pregnancy, obesity, reflux, diabetes gastroparesis, opioids, GLP-1 agonists, depressed consciousness, emergency surgery.
• RSI protects the high-risk airway — preoxygenate, rapid induction + fast NMB, cricoid with release if it worsens the view (Birenbaum: no clear aspiration benefit).
• If gross aspiration occurs: head-down/lateral if feasible, suction before positive pressure when possible, secure ETT, then decide cancel vs continue on clinical severity.
• NAP4: aspiration remains a major anaesthetic airway harm — risk recognition and planned airway strategy prevent more cases than heroic recovery.