Resident Manual of Trauma to the Face, Head and Neck

Chapter 10: Foreign Bodies and Caustic Ingestion

2. Pulmonary a. Atelectasis Atelectasis is usually asymptomatic and will resolve with patient mobility or incentive spirometer. b. Pneumonia Pneumonia may be the presenting symptom or may develop a few days following removal of the foreign body. Treat with antibiotic coverage as noted in I.F, above. If the patient’s symptoms do not improve with adequate therapy, a missed second foreign body should be considered. c. Bleeding Bleeding is usually from mucosal trauma or granulation tissue. This is often self-limiting. In rare instances, vessel erosion may lead to a significant bleed, requiring urgent thoracic surgery intervention. d. Pneumothorax or Pneumomediastinum Pneumothorax or pneumomediastinum is usually from a small perfora- tion in the airway that heals spontaneously and does not require further intervention. Symptomatic patients may be treated with oxygen and serial chest x-rays. If the pneumothorax or pneumomediastinum increases in size or is large on initial identification, a thoracic surgery consult should be called for further intervention. 3. Esophageal a. Bleeding Bleeding is usually from direct mucosal trauma and is self-limiting. Consider proton pump inhibitors and/or H2 blockers to prevent further injury to the damaged mucosa. b. Esophageal Perforation y y Early recognition and management of esophageal perforations have decreased the mortality rate from 60 percent to 9 percent from complications, such as a retroesophageal abscess or mediastinitis. y y Cervical subcutaneous emphysema, fever, tachycardia, tachypnea, and increased pain may all be early signs of a perforation. y y If a small esophageal perforation is suspected intraoperatively, place a nasogastric tube and perform a barium swallow or gastrografin study. If esophageal perforation is confirmed, keep the patient NPO, and consider broad-spectrum antibiotics. III. Caustic Ingestion The incidence of caustic ingestion has decreased since the Federal Hazardous Substances Act of 1960 and the Poison Prevention

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Resident Manual of Trauma to the Face, Head, and Neck