Patients who have had a witnessed episode of aspiration and who are otherwise healthy and exhibit no signs of infection or respiratory compromise may be discharged home with instructions to follow up with their primary care physician in 1 to 2 days. They should be instructed to watch for shortness of breath, fever, chest pain, unusual fatigue, or the development of a cough and to return to the emergency department or see their primary care physician promptly if any of these symptoms develop.
Patients who appear stable but have risk factors for worse or very aggressive disease (diabetes, old age, dialysis, recent stroke, chronic pulmonary disease, active cancer, HIV, etc.) should be admitted to either a hospital or an observation unit. Oxygen, fluids, and possibly antibiotics should be started and the patient followed carefully for 12 to 24 h. If stable after 12 to 24 h of treatment and observation, such patients can be sent home and instructed to follow up as described above and to return if any sign of deterioration develops. Patients with definite evidence of infection should be admitted and antibiotic treatment started. Patients who exhibit hemodynamic or respiratory instability require admission to an intensive care unit.
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