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[Dysphagia] disagree with doctor?
All pnuemonia is not aspiration, particulary not aspiration while
swallowing. If a VFSS looks good, consider GER (reflux) and look into
that; also left lower lobe is commonly atelectasis due to poor lung
expansion or secretions handling. Right middle lobe is classic for
aspiration just because of the anatomy of the right mainstem bronchus, but
positioning can lead to it being aspiration related in other areas as
well, so that is never a hard and fast rule. Theoretcially the only "gold
standard" for pneumonia being aspiration related would be an increased
lipid-laden macrophage index on bronchoscopy, and somethign that invasive
is just not often warranted.
Vikki Stefans, M.D., pediatric physiatrist (rehab doc for kids) at UAMS
and Arkansas Children's Hospital. Working Mom of Sarah T. and Michael C.,
and wife of Henry Stefans. Every mom is a working mom!- OK, dads too.
On Fri, 18 Aug 2006, Jonathan Bennett wrote:
> I'm curious about how many of you handle this type of situation. Of
> course, many of the patients that we see have pneumonia...but after I
> see a patient, sometimes I do not believe that it is being caused by
> aspiration, yet, the doctors are labeling it aspiration pneumonia. I am
> then put in the position where I have them on a regular diet and the
> family is asking how we are sure they won't end up with aspiration
> pneumonia again. If they end up back in the hospital, the doctors and
> family will be angry and once again, labeling it aspiration pneumonia,
> when in fact it may be viral, community acquired, etc. How do you
> handle both the patient and the doctor in these types of situations
> without losing respect of the doctors?
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