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Aspiration pneumonitis after reduced consciousness — SCE Acute Medicine MCQ

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ModerateMedicine in the ElderlyAspiration pneumonitis after reduced consciousnessSCE Acute Medicine

An 82-year-old man with Parkinson's disease vomits during a seizure and develops cough and transient hypoxia. Two hours later he is afebrile, oxygen saturation is 95% on 2 L/min oxygen and chest radiograph shows right lower-zone patchy change. White cell count is 10.8 x10^9/L. What is the most appropriate next step in management?

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Correct answer: E — Supportive care and close reassessment before antibiotics

Early post-aspiration hypoxia without persistent fever, sepsis or progressive infiltrate may represent aspiration pneumonitis, initially managed supportively with reassessment. Antibiotics are indicated if bacterial aspiration pneumonia develops or infection is likely. Steroids are not routine. The pearl is that pneumonitis and pneumonia overlap clinically, so reassessment matters more than a single early radiograph.

Reference: https://www.nice.org.uk/guidance/ng250#acute-medicine-order-73-1