Pediatric emergency medicine trisk 3109 3109
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (76.17 KB, 1 trang )
Clinical Considerations. Ingestions of acid and alkali caustics cause immediate
severe burning of exposed surfaces, usually with intense dysphagia. Associated
glottic edema may cause airway obstruction and asphyxia. Severe acid ingestions
most often cause gastric necrosis and may be complicated by gastric perforation
and peritonitis. With alkalis, severe damage is more commonly found in the
esophagus; deep-tissue injury may quickly lead to esophageal perforation,
mediastinitis, and death. As already noted, alkalis also produce severe esophageal
strictures in survivors.
Management. The initial step in the management of a caustic ingestion is to
determine whether the agent is, in fact, caustic and, if so, whether it is an alkaline
or acid caustic. Many products that are believed to have caustic potential (e.g.,
household bleach) are simple irritants and do not require intervention.
Identification of ingredients and their caustic potential can be found through
consultation with a regional poison control center.
The management approach to cleaning product and caustic ingestions, as
outlined in Figures 102.7 and 102.8 , begins with rapid clinical assessment of
cardiorespiratory function, neurologic status, and evidence of GI hemorrhage.
Life support measures may be needed emergently to secure the airway and to treat
shock or metabolic acidosis. Do not attempt to dilute or neutralize the agent and
do not attempt GI decontamination; these may worsen the injury. As noted
previously, most patients with significant exposures develop symptoms early and
may appear critically ill. However, even patients with minimal symptoms and the
absence of oral lesions may have significant esophageal injury; thus, patients with
a history of unintentional ingestion of a caustic substance with any signs and/or
symptoms suggestive of possible injury (including, stridor, vomiting, pain, and/or
drooling) merit upper GI endoscopy within 12 to 24 hours to be evaluated fully
for the presence of esophageal burns. Endoscopy is also recommended in all
patients with intentional ingestions. Endoscopy can classify esophageal burns
based on a grading system, as follows: hyperemia or edema without ulceration
(Grade I), noncircumferential submucosal lesions, ulcers, and exudates (Grade
IIa), near-circumferential submucosal lesions, ulcers, and exudates (Grade IIb),
and deep ulcers and necrosis (Grade III). This grading system can help determine
prognosis and guide management.
