Pediatric emergency medicine trisk 3112 3112
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ophthalmologic consultation. Skin contamination also deserves prolonged rinsing
with water and removal of contaminated clothing. Irrigate the skin until free of
alkali, as determined by disappearance of the soapy sensation.
Examine all exposed body surfaces, especially the oropharynx. Obtain a CBC
and chest radiograph; the latter particularly if any respiratory signs or symptoms
are noted. A lateral neck radiograph may be able to demonstrate evidence of
caustic epiglottitis.
Analgesic therapy may be necessary for severe pain. An IV line should be
established if not previously done for basic life support. There are conflicting data
regarding the role of corticosteroids in the treatment of caustic esophageal injury.
Grade I burns typically heal without long-term sequelae. Some evidence suggests
that Grade IIb burns may be less likely to stricture after steroid administration;
thus patients with Grade IIb burns should be treated with a short course of highdose methylprednisolone (1,000 mg/1.73 m2/day for 3 days), in addition to an H2
-antagonist and empiric antibiotics (Ceftriaxone). Grade III burns are likely to
scar despite treatment, and administration of steroids in this situation may provide
more risk than benefit. These patients should be managed in close consultation
with a gastroenterologist, otolaryngologist, or surgeon. All patients are admitted
for supportive care, nutritional therapy, and monitoring for acute complications
such as mediastinitis, pneumonitis, and peritonitis.
The long-term management of survivors with severe caustic esophageal burns
and stricture formation is complex, involving many surgical, medical, and
psychological stresses to the patient. Years of repeated dilatations may be
necessary, and some patients will require esophagectomy with colonic
interposition in an effort to replace the destroyed esophagus. The patient may be
incapable of tolerating solid foods for prolonged periods.
Two special household caustic circumstances merit special discussion. Hair
relaxing gels and pastes are alkaline caustic, but due to their packaging and
physical properties they are typically smeared onto the face, lips, and tongue by
curious young children. These agents may cause dramatic lip swelling, but rarely
cause esophageal or systemic injury. Laundry pods (single-use detergent sacs) are
widely available and are colorfully packaged, and so are commonly bitten by
young children. Asymptomatic children may be observed at home, but children
with vomiting or stridor should be evaluated emergently; local caustic injury,
CNS depression, and apnea have all been described.
Hydrocarbons
