Thursday, May 17, 2007
Often, things are not as they seem.
As an OT, one of my responsibilites is to make sure my patients can swallow their food and their meds and that all this goes down the right tube and into the stomach. We look for the telltale signs of aspiration, or food going into the lungs, such as coughing, voice change, and lack of a swallow reflex. We then proceed to make recommendations based on our observations. Too much food going down the wrong way, into the lungs, and that'll cause necrosis, granulation of lung tisse or infection (pneumonia).
However, people can be silent aspirators and this is where it gets complicated. Some people, because of decreased sensation or cognition, don't cough or choke on their food as it slides into their lungs and show no signs of aspiration. These are people who inhale their food, literally. As was the case with one of my patients this afternoon.
I don't know what tipped me off but for some reason, some suspicion, I requested a test in radiology for this patient. As I said, he ate well, but something rubbed me the wrong way. As soon as the test began, my eyes were glued to the screen in utter amazement as half of whatever he swallowed travelled into his windpipe and down to his lungs. Swallow after swallow, half into the stomach, half into the lungs; it was like he was drowning in his food. And of course, there he was, sitting amicably in the testing cubicle, happily eating away. It was the hardest thing to tell the patient and his family that his food was going into his lungs and not his stomach and that we'd have to put a tube in him to feed him.
So many times, things are not what they seem.
5 comments:
That's really scary! What happens to a patient who has food in their lungs? Does it need to be removed somehow? I'm really glad you decided to have him checked!
noope it just kind of sits there and is dissimilated and broken down by the body. it could also cause the lung tissue to rot...ewwww. =P
haha
oh frick. good call sheila. very greys anatmoy of you
Hmm, can it cause pulmonary edema? I know that near-drowning experiences, where some water is left in the lungs, an edema can occur and that's a terribly situation. At-risk victims need to sleep sitting up for three days after a near-drowning experiences.
pulmonary edema is more of a "plumbing" problem. it happens when fluid collects because circulation isn't working well. i've never heard of it happening when stuff is left in the lungs. i hope i never experience that though...the feeling of drowning out of water. it would give me nightmares.
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