Anaes Vivas · Critical incidents & patient safety
Bilious fluid at induction — aspiration viva
A clinical viva on pulmonary aspiration: the Mendelson fork, the risk stack with GLP-1 agonists, classic versus modified RSI with IRIS numbers, the SOILED bundle, and the cancel-or-continue rule.
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Prompt
A 68-year-old with small-bowel obstruction vomits bilious fluid past the cords at induction. Talk me through your distinction between chemical pneumonitis and pneumonia, your rapid sequence plan with the cricoid evidence, and your cancel-or-continue decision.
Stimulus
A 68-year-old with small-bowel obstruction vomits bilious fluid past the cords at induction. Talk me through your distinction between chemical pneumonitis and pneumonia, your rapid sequence plan with the cricoid evidence, and your cancel-or-continue decision[1][5].
References5ShowHide
- [1]Cook TM, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia Br J Anaesth, 2011.PMID 21447488
- [2]Birenbaum A, Hajage D, Roche S, et al. Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anesthesia: The IRIS Randomized Clinical Trial JAMA Surg, 2019.PMID 30347104
- [3]Sorbello M, et al. Pharmacological approach to rapid sequence induction/intubation: a contemporary perspective Curr Opin Anaesthesiol, 2025.PMID 40493782
- [4]Davies A. AANA Journal Course-GLP-1 Receptor Agonists: What CRNAs Need to Know About Their Expanding Role AANA J, 2026.PMID 42213027
- [5]Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anesthesia Am J Obstet Gynecol, 1946.PMID 20993766