Vomit aspiration, commonly referred to as choking on throw up, occurs when stomach contents are accidentally inhaled into the airways and lungs. This is a serious medical event that can lead to significant health complications.
The Mechanics of Aspiration
The body has natural defenses to prevent foreign material from entering the respiratory system. A primary defense is the epiglottis, a leaf-shaped flap of cartilage located in the throat. During normal swallowing, the epiglottis closes over the trachea (windpipe), directing food and liquids down the esophagus towards the stomach.
Additionally, the body’s cough reflex acts as a protective measure, expelling any foreign substances that might inadvertently enter the airway. However, these mechanisms can fail under certain circumstances, allowing vomit or other gastric contents to enter the lungs.
Factors Increasing Risk
Reduced levels of consciousness, which impair protective reflexes, significantly increase the risk of aspirating vomit. This includes individuals under the influence of alcohol or drugs, those experiencing seizures, or people with medical conditions like strokes that affect alertness.
Infants, young children, and the elderly are also at higher risk due to developing or diminishing reflexes and swallowing coordination. Conditions that affect swallowing, known as dysphagia, such as Parkinson’s disease, multiple sclerosis, or other neurological disorders, significantly elevate aspiration risk.
Gastroesophageal reflux disease (GERD) can also lead to stomach contents backing up into the throat, increasing the chance of aspiration, especially during sleep.
Recognizing the Signs and Consequences
Immediate signs of vomit aspiration include sudden coughing, gagging, or difficulty breathing. The person may also exhibit noisy breathing, such as wheezing or gurgling sounds, and their skin, lips, or nails might appear bluish due to lack of oxygen. In severe cases, there can be a sudden collapse or loss of consciousness.
Aspiration pneumonia, a lung infection caused by inhaled stomach contents, is a common and potentially life-threatening complication. This can result in symptoms like fever, shortness of breath, chest pain, and fatigue. If left untreated, severe aspiration can lead to acute respiratory distress syndrome (ARDS), lung abscesses, or even suffocation.
Prevention and Safety Measures
For infants, feeding in an upright position and avoiding lying them down immediately after feeding can help, usually for about 90 minutes. Thickening liquids for babies who have difficulty swallowing can also reduce aspiration risk, but this should be done under medical guidance.
For adults, managing conditions like acid reflux through medication or dietary adjustments can be beneficial. Avoiding lying flat immediately after eating and remaining upright for a period of time, such as 30 minutes, helps prevent stomach contents from re-entering the esophagus.
For individuals with impaired consciousness, ensuring they are positioned on their side can help drain any vomit away from the airway.
What to Do in an Emergency
Call for emergency medical services without delay. While waiting for help, position the person safely, ideally on their side, to allow vomit to drain from the mouth and prevent it from entering the lungs.
If the person is conscious and able to cough forcefully, encourage them to continue coughing to try and clear their airway. If they are unable to cough, speak, or breathe, standard first aid for choking, such as back blows and abdominal thrusts (Heimlich maneuver), may be necessary. However, emphasizing professional medical attention is important as these techniques require proper training.