Resident Manual of Trauma to the Face, Head and Neck

Chapter 10: Foreign Bodies and Caustic Ingestion

B. Primary Survey Initial evaluation should include assessing the patient for level of alertness, respiratory distress, and hemodynamic stability. Injury may range from upper airway edema, causing respiratory distress to gastric perforation and hemodynamic instability. Unstable patients may need to go emergently to the operating room. C. Patient History A complete patient history should be obtained (see section II.B). When obtaining the history think A ge, A mount, A gent, and time - A go. 1. Age and Amount Ingested Incidental ingestion is most common in children under 5 years of age. In these patients, the agent tends to be a common household supply. Ingested volumes are small, since the bitter taste makes the child spit out the remaining substance. Adolescent and adult caustic ingestions are more often intentional or suicide attempts, so a larger volume is often ingested. 2. Agent Ingested It is important to identify whether the agent was an acid or a base. If the agent is known, concentration and pH can often be found online or by calling the National Poison Center’s 24-hour National Poison Control Hotline (1-800-222-1222). Large volumes of strong acids are often needed to create injury, but only a few milliliters of a strong alkali can cause extensive damage instantaneously. Also, acids are more likely to result in chemical epiglottitis, which places the patient at high risk of airway obstruction. Besides the type of agent, try to determine whether it was in a liquid or granular form. Granules will need to be cleansed from the mucosa to prevent continued damage. 3. Timing of Ingestion Knowing the timing of the ingestion will help guide management. It is important to know when the caustic ingestion occurred to assess potential complications and whether the patient is a candidate for endoscopy. D. Symptoms y y Shortness of breath. y y Changes in voice. y y Dysphagia. y y Odynophagia. y y Chest pain.

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