Resident Manual of Trauma to the Face, Head and Neck

y y Tachycardia. y y Abdominal pain. E. Physical Exam

Early signs and symptoms do not correlate with the severity and extent of tissue injury. Up to 30 percent of patients with caustic esophageal injury do not show any evidence of oropharyngeal damage. The absence or presence of visible injury on physical exam should not influence further investigation. A full patient exam should include, but not be limited to, the following: 1. General Vital signs, alert, interactive. 2. HEENT y y Airway —Stridor, nasal flaring, retractions. y y Voice —Hoarse, breathy, muffled. y y Oral cavity/oropharynx —Burns, irritation, edema, fibrous exudates. y y Neck —Crepitus, mobility. y y Fiberoptic exam —Mucosal injury, fibrous exudates, supraglottic/ glottic edema. 3. Pulmonary y y Auscultation for wheezing or diminished breath sounds. 4. Abdomen y y Bowel sounds, tenderness to palpation, rigidity. F. Preoperative Management 1. Limit Fluid Intake Patients who present immediately after ingestion and are stable may be given water to dilute the ingested substance and rinse it from the esophagus. Fluid intake should be no more than 15 milliliters per kilogram of weight, as excess fluids may induce vomiting. Gastric lavage and induced vomiting are contraindicated. 2. Avoid Neutralizing Agents Avoid neutralizing agents. They may cause exothermic chemical reactions that will increase injury to the esophagus. 3. Apply Conservative Measures Conservative measures are recommended on presentation: y y Clean oral mucosa with water to dilute any remaining caustic material. y y Remove any visible granules to prevent continued injury.

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