Caustics

Question 1

Define caustics

Answer 1

Caustics are substances that cause both functional and histologic damage on contact with body surfaces.

Question 2

Classification of caustics

Answer 2

Caustics are broadly classified as alkalis (pH >7) or acids (pH <7).

Question 3

Caustics cause significant injuries at what ph?

Answer 3

Acids tend to cause significant injuries at a pH <3 and alkalis at a pH >11

Question 4

Following ingestion, solid or granular caustics often injure the ________ and _________, whereas liquid alkali ingestions are characterized by more ___________.

Answer 4

Oropharynx and proximal esophagus

extensive esophageal and gastric injuries

Question 5

_______________refers to the amount of acid or base required to neutralize the agent; the greater this value, the greater is the potential for tissue injury

Answer 5

Titratable acid or alkaline reserve

Question 6

visual endoscopic grading system:

involve tissue edema and hyperemia

Answer 6

Grade 1 burns

Question 7

visual endoscopic grading system:

include ulcerations, blisters, and whitish exudates, which are subdivided into two

Answer 7

grade 2 burns

grade 2A (noncircumferential) and 2B (deeper or circumferential) lesions

Question 8

visual endoscopic grading system

defined by deep ulcerations and necrotic lesions

Answer 8

grade 3 burns

Question 9

Following the initial mucosal injury, tissue remodeling occurs over roughly ________

Answer 9

2 months

Question 10

Early phases of remodeling, particularly _________after exposure, are associated with increased tissue friability and higher risk of perforation, both spontaneous and iatrogenic.

Answer 10

days 2 to 14

Question 11

Alkali injuries induce a deep tissue injury called _____________ necrosis

Answer 11

liquefaction necrosis

Question 12

most common household alkali is

Answer 12

bleach

Question 13

Quality of bleach

Answer 13

3% to 6% sodium hypochlorite solution with a pH of approximately 11

Question 14

_______________when bleach and ammonia household cleaners are combined

Answer 14

chloramine gas

Question 15

Injuries by strong acids produce _______ necrosis

Answer 15

coagulation

Question 16

key priority is

Answer 16

rapid airway assessment and stabilization

Question 17

Streaks of caustic burns on the face or chest are called

Answer 17

“dribble burns”

Question 18

True or false

Intentional ingestions are associ- ated with higher grades of GI tract injury, with or without clinically obvious signs

Answer 18

True

Question 19

the traditional gold standard for evaluating the location and severity of injury to the esophagus, stomach, and duodenum after caustic ingestion.

Answer 19

Endoscopy

Question 20

Early endoscopy is recommended after unintentional
caustic ingestions in adults and children with signs or symptoms of serious injury such as

Answer 20

stridor or significant oropharyngeal burns
and/or vomiting, drooling, or food refusal, with or without orpharyngeal burns.

Question 21

The primary purpose of endoscopy is

Answer 21

diagnosis

Question 22

Experts recommend that endoscopy should be performed early after ingestion, ____________ from the time of ingestion, to avoid iatrogenic perforation.

Answer 22

within 12 to 24 hours

Question 23

Tissue friability after a caustic burn increases significantly at ________hours after injury and is maximal between days ______, although endoscopy has been performed safely 5 days after exposure.

Answer 23

24 to 48 hours

Days 5 and 14

Question 24

_______________ is the first choice for definitive airway management.

Answer 24

Oral intubation with direct visualization

Question 25

Why is Gastric decontamination with activated charcoal is contraindicated if a caustic is the only ingestion?

Answer 25

Charcoal does not adhere well to most caustics and will impede visualization when endoscopy is performed.

Question 26

Ipecac syrup is contraindicated, why?

Answer 26

because vomiting will result in repeat exposure of the airway and GI mucosa to the caustic agent and could precipitate perforation

Question 27

True or false

do not insert nasogastric tubes until after endoscopic evaluation

Answer 27

True

Question 28

_____________is generally preferred over laparoscopic evaluation for posterior gastric visualization.

Answer 28

Laparotomy

Question 29

indications for emergency surgery include

Answer 29

esophageal perforation
peritoneal signs
free intraperitoneal air

Large-volume ingestions (>150 mL)
signs of shock
respiratory distress
persistent lactic acidosis
ascites
pleural fluid

Question 30

grade 2B and 3 injuries without obvious perforation, recommendations include

Answer 30

a period of esophageal rest, early gastrostomy for enteral feeding, and dilation therapy (in the first 3 weeks) with or without stenting.

Question 31

Disposition

Asymptomatic patients with low-risk ingestions and no signs of drooling, stridor, or vomiting and who tolerate food or drink may be

Answer 31

discharged from the ED after a period of observation

Question 32

grade 1 injuries disposition

Answer 32

can be discharged from hospital after endoscopy, provided they can tolerate oral fluids and food

Question 33

Grade 2a disposition

Answer 33

Grade 2A injuries warrant hospitalization to ensure that symptoms and injury do not progress.

Question 34

Grade 2B and 3 injuries disposition

Answer 34

are significant, require enteral or parenteral nutrition, and have an early risk for bleeding or perforation; admit these patients to an intensive care unit.