Emergency Management of Ingestion of Caustic Substances
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After caustic ingestion, a person’s most immediate risk to life is a loss of the airway, which can occur from direct contact during swallowing or emesis or from edema that extends locally from an injured esophagus. Because of the rapid progression of many injuries, particular attention should be paid to the inability to control oral secretions or a change in voice, indicating impending airway compromise.

Because the safety of further evaluation with CT or endoscopy depends on airway security, its recommend placement of a definitive airway at the first sign of a change in voice, an inability to tolerate secretions, stridor, or other markers of potential airway compromise. Accepted guidelines for patients with difficult airways should be followed. Although it is tempting to focus on injuries to the aerodigestive tract after caustic ingestions, potential injuries to the skin and eyes that may result from splashes, spills, or emesis also need to be considered. Clothing should be removed and exposed, and the skin irrigated with copious amounts of water. Immediate irrigation of the eyes is indicated when ocular exposure is suspected, followed by advanced management in consultation with an ophthalmologist.

The standard toxicologic principles of gastrointestinal decontamination do not apply to patients with caustic ingestions since clinical attempts to empty the stomach can potentially increase injury. In addition, activated charcoal does not adsorb caustics, and adherent particles of activated charcoal will obscure endoscopic visualization. Although blind nasogastric-tube insertion has occasionally been recommended for acid ingestions

A single exception would be the use of water immediately after ingestion (usually at home) to irrigate adherent materials in the oropharynx or esophagus if the patient can swallow, speak clearly, and breathe without difficulty.As with thermal cutaneous burns, assessment and maintenance of fluid and electrolyte balance are essential. Strict monitoring of hemodynamics is recommended since many patients are unable to take oral fluids and insensible fluid losses are associated with extracellular fluid shifts in response to tissue injury. A decision to perform surgical débridement is based on evidence of full-thickness tissue injury, perforation, or hemodynamic instability.

Source:https://www.nejm.org/doi/full/10.1056/NEJMra1810769?query=featured_gastroenterology
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