Resident Manual of Trauma to the Face, Head and Neck

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

14

Resident Manual of Trauma to the Face, Head, and Neck