USMLE 2 EM Quick Notes
Caustic ingestion
| features | chemical burn or liquefaction necros s results in: ▪ laryngeal damage: hoarseness, stridor, orofacial inflammation ▪ esophageal damage: dysphagia, odynophagia ▪ gastric damage: epigastric pain, GI bleeding |
| management | ▪ ABCs ▪ remove contaminated clothing, irrigate exposed skin ▪ upper GI XR with water-soluble contrast for suspected perforation ▪ CXR if respiratory symptoms ➢ upper endoscopy within 24 hr ▪ barium contrast (2 – 3 wks) |
| complications | ➢ esophageal strictures ➢ pyloric stenosis ▪ ulcers, perforation ▪ cancer |
| ▪ avoid interventions that provoke vomiting (activated charcoal, milk, vinegar, NG lavage) ➢ in absence of perforation, upper endoscopy within 12 – 24 hr to assess damage & guide therapy |
| ▪ MCC blunt abdominal trauma: MVAs ▪ MC injured: liver & spleen o free peritoneal fluid should raise suspicion for liver or splenic laceration ▪ hemodynamically unstable & free intraperitoneal fluid on USS ◇ emergency laparotomy ▪ hemodynamically stable splenic lacerations & no evidence of other intra-abdominal injuries ◇ non-operative management |
| ▪ blunt abdominal trauma can cause splenic injury ▪ delayed onset hypotension, LUQ pain radiating to left shoulder 2/2 diaphragmatic irritation (Kehr sign) ▪ Dx: abdominal CT with contrast if hemodynamically stable ▪ hemodynamic instability despite IV fluids requires laparotomy |
| ▪ encephalopathy, ocular dysfunction, gait ataxia: Wernicke encephalopathy ▪ giving IV fluids containing glucose prior to thiamine can precipitate or worsen WE ➢ thiamine is given along with or before glucose |
| ▪ battery ingestion requires an XR ▪ batteries in the esophagus should be removed under endoscopic guidance to prevent mucosal damage & esophageal ulceration ▪ batteries distal to the esophagus need observation with stool exam or follow-up XR ▪ do not use NG tube or induce vomiting |
