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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.