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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.