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Resident Manual of Trauma to the Face, Head, and Neck
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Chapter 10: Foreign Bodies and Caustic Ingestion
............................... 214
I.
Anatomy
................................................................................................ 214
A. Upper Airway................................................................................. 214
B. Lower Airway ................................................................................ 214
1. Right Main Bronchus ............................................................. 215
2. Left Main Bronchus................................................................. 215
C. Alimentary Tract............................................................................ 215
1. Hypopharynx ........................................................................... 215
2. Esophagus................................................................................. 215
3. Stomach .................................................................................... 215
II. Foreign Bodies
..................................................................................... 215
A. Primary Survey............................................................................... 216
B. Patient History............................................................................... 216
1. Phases of Aspiration............................................................... 216
2. Symptoms................................................................................. 216
3. Information Gathering........................................................... 217
C. Physical Evaluation....................................................................... 217
1. General....................................................................................... 217
2. Head, Eyes, Ears, Nose, and Throat.................................... 217
3. Pulmonary................................................................................. 217
4. Abdomen................................................................................... 218
5. Fiberoptic Exam....................................................................... 218
D. Imaging............................................................................................ 218
1. Aspiration.................................................................................. 218
2. Ingestion................................................................................... 220
E. Management................................................................................. 220
1. Special Considerations......................................................... 220
2. Endoscopy................................................................................ 220
3. Controversies in Management: Flexible versus
Rigid Endoscopy......................................................................222
4. Postoperative Management.................................................223
F. Prevention and Management of Complications....................223
1. Indications for Antibiotics.....................................................223
2. Pulmonary................................................................................ 224
3. Esophageal............................................................................... 224
III. Caustic Ingestion
............................................................................... 224
A. Categories of Caustic Materials................................................225
1. Acids (pH <7)..........................................................................225
2. Alkali (pH >7)..........................................................................225
3. Bleach (pH ~7).........................................................................225
B. Primary Survey.............................................................................. 226
C. Patient History.............................................................................. 226
1. Age and Amount Ingested................................................... 226
2. Agent Ingested........................................................................ 226