L3: Caustics Flashcards
1
Q
Def of Corrosives
A
2
Q
Classification of Corrosives
A
- Mineral acids
- Organic acids
- Alkalies
- Corrosive salts
- Button batteries
3
Q
Examples of corrosive Organic acids
A
Carbolic Acid “Phenol”
Oxalic Acid
Acetic Acid.
3
Q
Examples of corrosive mineral acids
A
Sulphuric Acid
Nitric Acid
Hydrochloric Acid.
3
Q
Examples of corrosive salts
A
Mercuric Chloride.
3
Q
Examples of corrosive alkalis
A
Caustic Potash
Na Hydroxide
Ammonium Hydroxide.
4
Q
what do button battries contain?
A
- Contain in mercuric chloride
- used in watches and calculators.
5
Q
manner of poisoning by Corrosives
A
In children: 85% accidentally ingested in children between 1-3 years.
In adult: Intentional exposures by adults are more significant (done by suicidal patients).
5
Q
what are forms of corrosives?
A
bleach, household cleaners, paint and rust removers and strong lyes.
6
Q
Clinical picture of Corrosive Toxicity
A
- Patients who have ingested alkaline or acid agents have similar initial. presentations
- They most commonly affect gastrointestinal, respiratory, eye and skin.
7
Q
GIT manifestations in Corrosive Toxicity
A
- Pain
- Dysphagia
- Others
8
Q
GIT Pain in Corrosive Toxicity
A
- Corrosions and burning pain of of lips and oral cavity.
- Severe chest or abdominal pain (in esophageal or gastric perforation)
9
Q
what is the most common symptom of Corrosive Toxicity?
A
Acute dysphagia
10
Q
Dysphagia in Corrosive Toxicity
A
- Dysphagia (inability to tolerato oral fooding)
Acute dysphagia: The most common symptom
Chronic dysphagia: Stricture formation
11
Q
Other GIT Symptoms in Corrosive Toxicity
A
- Drooling
- Hypersalivation
- Vomiting
- Hematemesis
- Shock
12
Q
Does Presence or absence of oral lesions predict severity of burn?
A
No
13
Q
Mechanism of Respiratory manifestations in Corrosive Toxicity
A
- By Direct exposure of upper respiratory tract to corrosive substance, inhalation of corrosive gases
(e.g. chlorine and ammonia) and aspiration of vomitus
14
Q
respiratory Manifestations of Corrosive Toxicity
A
- Injury in Upper respiratory tract: (Epiglottitis, laryngeal edema & ulceration)
- Stridor & Hoarseness.
- Dysphonia & Aphonia
- Dyspnea, Wheezing & Coughing.
- Pneumonitis “Impaired gas exchange & Pulmonary edema “Non-cardiogenic”
15
Q
Systemic manifestations of Corrosive Toxicity
A
- Can occur after inhalation, skin exposure or ingestion of agents with systemic effects.
16
Q
what are corrosives that cause systemic manifestations?
A
- Hydrofluoric acid, Oxalic acid and Carbolic acid.
17
Q
Complications of Corrosive Toxicity
A
- Early
- Late
18
Q
Early complications of Corrosive Toxicity
A
19
Q
Late Compliacations of Corrosive Toxicity
A
20
Q
Laboratory Investigations of Corrosive Toxicity
A
21
Radiological investigations of **Corrosive Toxicity**
- X-rays of the chest and abdomen
- CT scans
- Endoscopy.
22
X-ray of the chest & abdomen in **Corrosive Toxicity**
- Free mediastinal and intraperitoneal air adjacent to liver
- Pulmonary aspiration and Chemical pneumonitis.
- Impacted button batteries
23
what does Free mediastinal and intraperitoneal air adjacent to liver denote in **Corrosive toxicity**?
esophageal or gastric perforation
24
what CT Scans are done in **Corrosive Toxicity**?
Barium swallow CT scan
25
Time of doing Barium swallow CT Scan in **Corrosive Toxicity**
Follow-up contrast studies 3-4 weeks after the injury if dysphagia is present.
25
when sould EGD by Done in **Corrosive Toxicity**?
- Should be performed within 12 to 24 hours after ingestion.
26
Endoscopy in **Corrosive Toxicity**
**Esophagogastroduodenoscopy (EGD)**
- Flexible endoscopy is the standard diagnostic tool in symptomatic patients.
27
Aspects of TTT in **Corrosive Toxicity**
- Observation
- Emergency and supportive measures
- Decontamination
- Symptomatic treatment
28
Observation in **Corrosive Toxicity**
Asymptomatic & Symptomatic
29
Observation of asypmtomatic patients in **Corrosive Toxicity**
- Asymptomatic case with unintentional caustic ingestions should be subject to close observation and monitoring for 4 hours, without the need for endoscopy.
- If the patient remains asymptomatic and able to eat and drink, he can be discharged with appropriate follow-up.
30
Observation of sypmtomatic patients in **Corrosive Toxicity**
- All symptomatic cases require admission to the intensive care unit should avoid any oral intake because of risk of perforation.
31
Emergency TTT in **Corrosive Toxicity**
32
Decontamination in **Corrosive Toxicity**
- Inhalation
- Skin & Eyes
- Ingestion
33
RESP Decontamination in **Corrosive Toxicity**
- Remove from exposure
- Give supplemental oxygen if available.
34
Skin & Eyes Decontamination in **Corrosive Toxicity**
- Remove all clothing
- Wash skin and irrigate eyes with copious water or saline.
35
Gastric Decontamination in **Corrosive Toxicity**
Prehospital & Hospital
36
Prehospital gastric Decontamination in **Corrosive Toxicity**
- DO Dilution: With 1-2 cups of milk or water
- Early & Late
- Do not do Neutralization
37
Hospital Decontamination in **Corrosive Toxicity**
37
Early dilution in **Corrosive Toxicity**
**(Recommended)**
- Within the first few minutes after ingestion.
- In alert patients who are not vomiting, can tolerate liquids, have no airway compromise and not complaining chest or abdominal pain.
37
Late dilution in **Corrosive Toxicity**
- not recommended because vomiting may occur.
38
Neutralization in **Corrosive Toxicity**, Is it indicated?
No
- Do not give pH-neutralizing solutions (diluted vinegar or bicarbonate), As it worsen tissue damage by forming gas and exothermic reaction.
39
Symptomaic TTT in **Corrosive Toxicity**
- Parental nutrition
- Gastric acid reduction
- Antiemetics
- Analgesic
- Corticosteroids
- Antibiotics
- Surgical consultation
- Endoscopy
40
Is oral intake Recommended in **Corrosive Toxicity**?
No, Withholding oral intake until the condition stabilized
41
Parentral nutrition in **Corrosive Toxicity**
Total parenteral nutrition should be instituted rapidly.
42
Gastric acid reduction in **Corrosive Toxicity**
H2 Antagonists, and/or Proton Pump Inhibitors.
43
Antiemetics in **Corrosive Toxicity**
In children to prevent additional esophageal injury from emesis
44
analgesics in **Corrosive Toxicity**
Narcotic analgesics to reduce the pain.
45
Corticosteroids in **Corrosive Toxicity**
**Recommended:**
- In patients with circumferential superficial ulcers in esophagus after corrosive ingestion, Intravenous dexamethasone should be administered for a short period (3 days),
- To prevent the development of esophageal stricture.
**Not recommended:**
- In a patient with perforation
- Corticosteroid may be harmful because they mask early signs of inflammation.
46
Surgical consultation in **Corrosive Toxicity**
Immediate surgical consultation in esophageal and gastric perforation.
46
Antibiotics in **Corrosive Toxicity**
- Broad spectrum antibiotics (Cephalosporin) indicated in:
* If their evidence of a superficial and deep ulcers in esophagus
* If there is evidence of perforation.
* If there is evidence of mediastinitis or peritonitis.
If corticosteroid therapy is used.
47
Endoscopy TTT in **Corrosive Toxicity**
**Endoscopic dilation**
- For esophageal stricture and gastric outlet obstruction.
**Endoscopic removal**
- "immediately" for any lodged Button Batteries in / esophagus or trachea.
48
Characters of **Phenol (Carbolic acid)**
- Phenol has characteristic odor.
49
Uses of Phenol (Carbolic acid)
- It is one of the oldest antiseptic agents.
- Currently it is used as a disinfectant.
50
Forms of **Phenol (Carbolic acid)**
Phenolic compounds include
- Dinitrophenols
- Hydroquinone
- Hexachlorophone
- Creosol
- Chloroxylenol (in Detlol)
51
Execretion of **Phenol (Carbolic acid)**
- Its elimination half-life is 0.5-4.5 hours.
52
Absorbtion of **Phenol (Carbolic acid)**
- Rapidly absorbed following inhalation, skin exposure and ingestion.
53
CP of **Phenol (Carbolic acid)**
It can give both local and systemic effects
53
Manifestation due to local actions of **Phenol (Carbolic acid)**
- Skin exposure
- Eye exposure
- Lung exposure
- GIT exposure
54
Skin exposure to **Phenol (Carbolic acid)**
- It produces painless deep white patches that turn erythematous (red) and finally brown.
- Phenol appears to have local anesthetic properties and can cause extensive damage before pain is felt.
55
Eye exposure in **Phenol (Carbolic acid)**
- Contact with eyes produces irritation and severe corneal damage.
56
Lung exposure in **Phenol (Carbolic acid)**
- Inhalation produces respiratory tract irritation, tracheobronchitis and chemical pneumonia.
57
GIT Exposure in **Phenol (Carbolic acid)**
- Ingestion causes diffuse local corrosions, pain, nausea, vomiting and diarrhea.
58
Cardiac manifestations due to **Phenol (Carbolic acid)**
- Hypotension and arrhythmias.
58
Manifestations due to systemic action of **Phenol (Carbolic acid)**
- Cardiac
- Metabolic
- Neural
- Renal
- Hematological
59
Neural manifestations due to **Phenol (Carbolic acid)**
**1st:**
- Initial, transient CNS stimulation
(Agitation, confusion & seizures).
**2nd:**
- Followed rapidly by CNS depression.
(Lethargy or coma & respiratory arrest).
60
Metabolic manifestations due to **Phenol (Carbolic acid)**
- Acidosis and shock
61
Renal manifestations due to **Phenol (Carbolic acid)**
- Acute toxic glomer/onephritis which causes acute renal failure.
- Oliguria (scanty urine) and albuminuria.
- Urine Contains red cast and turns green if exposed to air (Due to presence of oxidative product of phenol).
62
Hematological manifestations due to **Phenol (Carbolic acid)**
Hemolysis and methemoglobinemia in some phenolic compounds (eg, dinitrophenol and hydroquinone).
63
TTT of **Phenol (Carbolic acid) Toxicity**
- Emergency and supporlive measures
- Decontamination
- Antidote
- Enhanced elimination
64
Emergency TTT of **Phenol (Carbolic acid) Toxicity**
65
Decontamination in **Phenol (Carbolic acid) Toxicity**
- Inhalation
- Skin and eyes
- Ingestion
66
RESP decontamination in **Phenol (Carbolic acid) Toxicity**
- Remove victims from exposure and administer supplemental oxygen.
67
Ingestion decontamination in **Phenol (Carbolic acid) Toxicity**
67
Skin & Eyes decontamination in **Phenol (Carbolic acid) Toxicity**
- Remove contaminated clothes and wash exposed skin with soapy water or olive oil.
- Immediately flush exposed eyes with water or saline for at least 15 minutes.
68
When to consider Gastric lavage in **Phenol (Carbolic acid) Toxicity**?
if:
- A large dose has been ingested.
- The patient's condition is evaluated within 30 minutes.
- The patient has oral lesions or persistent esophageal discomfort.
69
When to avoid Gastric lavage in **Phenol (Carbolic acid) Toxicity**?
- Gastric lavage is not necessary after small to moderate ingestions if activated charcoal can be given promptly.
70
Caution during gastric lavage in **Phenol (Carbolic acid) Toxicity**
Care must be taken when placing the nasogastric tube
71
Antidote in **Phenol (Carbolic acid) Toxicity**
- No specific antidote is available.
- Methylene blue: If methemoglobinemia occurs, administer it.
72
Enhanced Elimination in **Phenol (Carbolic acid) Toxicity**
- Repeated dose activated charcoal in hexachlorophene (excreted in the bile).
73
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