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Caustics

Caustics. intro. pathophys. grade 1 burns involve tissue edema and hyperemia grade 2 burns include ulcerations, blisters, and whitish exudates grade 2A (noncircumferential) and 2B (deeper or circumferential) lesions grade 3 burns are defined by deep ulcerations and necrotic lesions .

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Caustics

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  1. Caustics

  2. intro

  3. pathophys • grade 1 burns involve tissue edema and hyperemia • grade 2 burns include ulcerations, blisters, and whitish exudates • grade 2A (noncircumferential) and 2B (deeper or circumferential) lesions • grade 3 burns are defined by deep ulcerations and necrotic lesions

  4. pathophys • Alkali • immediate cellular destruction via protein denaturation and lipid saponification • liquefaction necrosis • Acid • When it reaches the stomach, gastric necrosis, perforation, and hemorrhage may result. • Coagulation necrosis

  5. Clinical features • asymptomatic to odynophagia, dysphonia, oral and facial/dribble burns, respiratory distress, abdominal pain, drooling, coughing, dyspnea, or vomiting • Order labs and images based on patient presentations

  6. treatment • Airway • Activated charcoal relatively contraindicated • Fluid resuscitation • Endoscopy • Early if intentional and unintentional with severe symptoms • Ideally within the first few hours post ingestion

  7. treatment • No benefits with corticosteroids or antibiotics • For ocular exposures, irrigate the eyes for at least 15 minutes • Type of fluid is not as important as immediacy of irrigation is

  8. Special circumstances • Disk batteries • Immediate removal if in airway or esophagus, repeat radiographs if advanced into the stomach • HF acid • Minor burns • Gel paste of calcium gluconate • Severe burns • intradermal injections of 5% calcium gluconate Can do intra-arterial calcium gluconate

  9. References • Tintinalli, Ch. 194

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