143 Caustic Ingestion Flashcards
(21 cards)
Name common caustic ingestions from household products (ie list 5 products)
meth making: H2so4 +hcl + naoh +amoonium OH + metalli Li
cement
drain cleaner - liquid or solid
oven cleaner
rust remove
toilet bowl cleaner
swimming pool cleaner
pills: Kcl, doxycycline, antimalarials
Name 6 factors influencing pathophysiology of caustic ingestion
Type of agent
Concentration of solution
Volume
Viscosity (low = easier penetration of tissues)
Duration of contact
pH
Presence or abscence of food in stomach
What process causes cell death via acids?
coag necrosis is a type of cell death that occurs when blood flow to cells stops or slows (ischemia).
eschar
Why is eschar important?
stops acid flow deeper
Why are acids more lethal mortality wise?
systemic spread: metabolic acidosis
spread to various organs (kidney, liver etc)
What process causes cell death via alkalis?
liquefaction necrosis
fat sponification
pro disruption
What is liquefaction necrosis?
type of cell death where dead tissue transforms into a liquid, viscous mass. = further penetration than acids
Pyloris burns in alkalis: mortlaity above pylorus vs below
50% below
9% above
Name IV stages of Zargar classifcation for endoscopy defn of injury grade
GRADE 1: edema, hyperemia
GRADE 2: superficial ulcer, white membranes, exudates, fribability, hemorrhage
a. Noncirumferential
b. Nearly circumferential
High risk of stricture formation
GRADE 3: Transmural involvement with deep injury, necrotic mucosa, perforation of stomach or esophagus
High risk of stricture formation
Grade IV: see perforation
Clinical features of caustic ingestion
Priorities (airway and gastric/esophageal perforation):
GI - visible burns face/lips, along the tract (oral pain, abdo pain, vomiting, drooling)
Resp: wheeze, cough, resp distress, hoarse, odynophagia, dysphagia, stridor
Hx of ingestion and new dysphagia 2-8 weeks later?
STRICTURE
NAME DIAGNOstic tests for caustic ingestion
Product label - family, poison control or pH testing
Nasopharyngoscopy - tongue, supraglottic area and glottic area
Flexible endoscopy - esophagus and stomach
CT chest AND abdo for perforation
Esophagram with water soluble contrast (historically barium, often gastrograffin)
Labs: VBG - metabolic acidosis, coagulation profile, hemoglobin, extended electrolytes
What is so special/needs testing for HF?
concerns for fluoride causing hypocalcemia –> EKG for assessment of QTC prolongation, torsades, or ventricular dysrhythmia
when is best to endoscopy for caustic ingestion?
Within 12-24 hours of intentional ingestion to define disease extent
NOT in patients with likely or known perforation
Beyond 24 hours = further risk
Management of a caustic ingestion
IV O2 Monitor
Airway BCDE
Consideration of bronchoscope for edema vs VL
Dexameethasone 10mg IV if airway edema
Supportive care for blood pressure
DO NOT induce emesis
*Exceptions to the GI decontamination rule: zinc chloride and mercuric chloride (cationic metal can become systemic - stop that)
Surgery: free air, peritonits, increasing/severe chest and abdo pain, OR signs of perforation on imaging,
Iodine overdose tx recommendations
Gastric irrigation with starch or milk to converte iodineto iodide ( goal: gastric effluent dark blue or purple within 30-45 mins)
Phenol and formaldehyde od and tx
Protein denatruation and coagulation necrosis
Dermal = irrigation with water
Hydrogen peroxide special complication?
gas emboli!
same sx as dysbarism - therefore ct chest abdo
tx hydrogen peroxide od with gas embolism?
hyperbaric o2
Button battery injuries
pressure necrosis, caustic injury due to alkali leak, electrical injury
Tx of button batteries:
Airway or esophagus = removal > single gastric or intestinal = watchful wait
