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Aspiration pneumonitis after witnessed vomiting — SCE Acute Medicine MCQ

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ModerateAcute Respiratory PresentationsAspiration pneumonitis after witnessed vomitingSCE Acute Medicine

A 46-year-old man with alcohol dependence vomits and then develops acute hypoxia on the ward. Temperature is 37.3 C, WCC 10.8, CRP 22, and chest radiograph two hours later shows patchy right lower-zone infiltrate. He is tachypnoeic but haemodynamically stable. What is the most appropriate initial approach?

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Correct answer: B — Supportive care with close observation and reassessment for evolving infection

Early aspiration pneumonitis is a chemical injury and may be managed supportively if there is no convincing established infection. Antibiotics become appropriate if fever, inflammatory markers or clinical deterioration suggest aspiration pneumonia. Bronchoscopy is not routine unless large particulate obstruction is suspected. The teaching point is to distinguish aspiration pneumonitis from pneumonia rather than treating every witnessed aspiration identically.

Reference: BTS aspiration pneumonia clinical statement, NICE CKS chest infections