A 67-year-old male with a history of esophageal cancer is brought to the emergency department after experiencing a sudden onset of coughing and respiratory distress during a meal. On examination, the patient is febrile, tachypneic, and has decreased breath sounds in the right lower lung field. What is the MOST appropriate initial management for this patient?
Advise keeping the patient NPO and prepare for a barium swallow study
Administer broad-spectrum antibiotics to cover for possible aspiration pneumonia
Immediate suctioning of the oropharynx and administration of supplemental oxygen
Institute bronchodilator therapy to improve airflow
In a patient with suspected aspiration, particularly with a history of esophageal cancer increasing the risk of aspiration, the initial management should focus on airway clearance and oxygenation. Suctioning to clear the aspirated material can help prevent further obstruction and complications related to aspiration pneumonia. While broad-spectrum antibiotics are important in the treatment of aspiration pneumonia, the immediate focus should be on stabilizing the airway and breathing, hence antibiotic administration is not the primary initial step. Bronchodilators may be helpful if there is a component of bronchospasm or reactive airways, but it does not address the primary issue of aspirated material. Preventative measures such as keeping the patient NPO (nothing by mouth) are essential but are not an immediate intervention for management at the time of presentation.
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