Understanding Aspiration: Revisiting the Term Dead Drunk



Aspirating stomach contents is most commonly experienced by individuals who are in an altered state of consciousness, e.g., head trauma, under anesthesia, under the influence of alcohol or other drugs, etc.

When in such an altered state of consciousness, bile and other stomach contents, i.e. vomit, can be aspirated or "inhaled" into the lungs if the individual is lying on his or her back and vomits while passed out.

This is a phenomenon that has been known for most of recorded history, e.g., Atilla the Hun is reported to have died on his wedding night in 467 AD as a result of aspirating vomit and/or blood while in a drunken state; aspirated vomit contributed to the deaths of Janis Joplin, John Belushi, Jimmi Hendrix

Problems associated with aspirated stomach contents fall into three broad categories - 1) obstruction of the airway and flooding of the lungs, i.e., "drowning," 2) chemical pneumonia or damage to the lining of the lungs due to acid burning - if the ph of the aspirated material is lower than 2.5, the result is chemical damage to the lining of the lungs, which precludes normal respiration, 3) bacterial pneumonia, which results from inhaling pathogens or "bacteria."

Recovery from the effects of inhaling a small quantity of aspirant is rather quick, 24 to 48 hours. Chemical or bacterial pneumonia, i.e., "aspiration pneumonia" is much more serious and treatment can take an extended period of time and require the use of antibiotic medications.

Standard training for resident life staff in most colleges and universities includes the early detection and prevention of aspirating stomach contents when intoxicated. This phenomenon, often mistakenly referred to as "alcohol poisoning, can result in "aspiration pneumonia." This training consists of knowing the signs of individuals who are at high-risk for this phenomenon and precautions when caring for the excessively intoxicated student. These include, 1) place the individual's back to a wall, pillows in front to preclude rolling onto one's back or stomach, thereby lessening the chance of aspirating vomit should the individual become sick.

True "alcohol poisoning" results from achieving a blood alcohol level so high as to anesthetize the vital reflexes associated with circulation and respiration. This is a true "alcohol overdose" with the same consequences as those associated with an overdose of any central nervous system depressant drug, barbiturates for example.

While not an uncommon phenomenon, a relatively small portion of any collegiate student body is at risk of aspiration as the majority of college students (56%) drink 4 or fewer drinks per outing and of those who drink more, many do not consume enough to suppress their gag reflex or become so intoxicated as to be unable to right themselves if they need to vomit.

To read more about the risks associated with aspirating stomach contents when excessively intoxicated, visit this webpage at Loyola Marymount University - http://www.lmu.edu/Page25064.aspx

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