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CAUSTIC INGESTION

These pages are excerpted from the Trauma Resident Handbook, Rhode Island Hospital Department of Surgery, Division of Trauma - updated 2001. The policies herein are intended to serve as guidelines only. Individual circumstances need to be considered as there may be times when it is appropriate or desirable to deviate from these guidelines. These educational guidelines will be reviewed and updated routinely.

All pediatric patients with caustic burns to the esophagus or oropharynx will be treated jointly by Pediatric Surgery and Pediatric Gastroenterology. Either service may serve as the admitting service, with the other following the patient in consultation.

1. Stabilization of airway by either emergency physician or trauma surgeon. ENT consult to evaluate the extent of pharyngeal injury via flexible laryngoscopy when severe airway manifestations (e.g., stridor) are present.
2. Indications for immediate EGD include airway symptoms (e.g., stridor), spontaneous vomiting, significant pain, and buccal mucosal lesions. Patients with active psychiatric disorders can be difficult to assess and should be strongly considered for endoscopy on an independent basis.
3. Asymptomatic patients can be observed in the ED for 6 hours and then reevaluated for progression of symptoms.
4. Steroids for patients with airway edema and gastrointestinal second- and third- degree burns. During therapies to follow steroid use include prophylactic antibiotic coverage for anaerobic organisms (e.g., penicillin) and H2 antagonists.
5. Diagnostic studies to include plain radiographs (soft tissue neck, chest, upright abdomen, and KUB), oral contrast swallow (for perforations), and CT chest (for mediastinitis).
6. Notify services upon patient’s arrival.

Rev. 8/5/03

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