USMLE 2 EM Quick Notes

Caustic ingestion

featureschemical burn or liquefaction necros s
results in:
▪ laryngeal damage: hoarseness, stridor, orofacial inflammation
▪ esophageal damage: dysphagia,
▪ 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