HSC Section 3 - Trauma, Critical Care and Sleep Medicine

J.H. Bird et al.

Patient presents with caustic ingestion injury • Focused History – determine substance and concentration • Observations – Resuscitate in compliance with ALS guidelines • Airway assessment – ENT & anaesthetics

Definitive airway

Critical/Unstable Airway

• Surgical tracheostomy • Endotracheal intubation

Commence medical therapy until patient stable for further assessment

Airway stable: If laryngeal oedema present:

Airway deterioration/ Clinical concern

Dexamethasone(with antibiotic cover) Adrenaline nebulizers

•

• • •

Analgesia

Regular airway assessment

Are there any clinical or radiological signs of perforation? • Peritonitis • Surgical emphysema • Free air on CXR

Yes

• Urgent general surgery or paediatric surgery opinion

No

• Admit for a period of

No

Is there persistent pain, dysphagia, odynophagia or drooling?

observation and consider discharge if patient remains asymptomatic and senior staff satisfied.

Yes

• Arrange for OGD within the next 24 hours to grade degree of injury. • Start high-dose PPI intravenously. • Commence broad-spectrum antibiotics if suspected chemical pneumonitis.

• Symptomatic relief and

Grade 2 injury or worse

parenteral nutrition until oral diet tolerated.

• Follow up with

gastroenterology due to high risk of developing delayed complications.

Grade 0 or grade 1injury

• Patient low risk of developing complication. • Discharge when oral diet tolerated. • Psychiatric review in cases of deliberate self-harm. • No other follow-up required

Fig. 1. An evidence-based guideline for the management of caustic ingestion injuries.

© 2016 John Wiley & Sons Ltd Clinical Otolaryngology 42 , 701–708

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