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Caustic Ingestion andForeign Bodies of theAerodigestive Tract
Dr Dony Hartanto SpTHT MKes
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Caustic Ingestion Esophagus, pharyn, !aryn
Bases Drain c!eaners
E!ectric dish"asher soap
Hair re!aant
Acids
B!eaches
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Caustic Ingestion #,$$$ !ye ingestions in chi!dren % #
years
Most in &itchen
High fa'i!y stress
Suicide atte'pts in adu!ts
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Caustic Ingestion A!&a!is ( pH ) *
+iuefaction necrosis
Acids ( pH % * Coagu!ation necrosis
B!eaches ( pH - * Irritants
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Caustic Ingestion A'ount
Type
Concentration Ti'e of contact
Acute phase
+atent period
Stricturefor'ation
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Caustic Ingestion Initia! 'anage'ent reuires
diagnosis
History
./tain container
0oison contro!
E'esis1
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Caustic Ingestion +aryngea! in2ury1
Hoarseness, stridor, dyspnea
Severe in2ury1 .dynophagia, droo!ing, refusa! of food
0erforation1 Chest pain, a/do'ina! pain, rigidity
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Caustic Ingestion 3eigh/oring in2ury
Ea'ination of !ips, chin, hands,
chest, c!othing .ropharyn
Suction, !ighting, restraint
+aryn4hypopharyn F!ei/!e 5/eroptic scope, 'irror
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Caustic Ingestion 6adio!ogic ea'
Chest 7 nec& radiographs
Bariu' s"a!!o" 8i!! not revea! 9stand :nddegree
in2uries
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Caustic Ingestion Esophagoscopy in virtua!!y a!! patients at
:; ?ei/!e de/ata/!e
Endoscopy to upper !i'it of severe /urn
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Caustic Ingestion @rade 9 < super5cia! in2ury
@rade : ( trans'ucosa! in2ury
@rade ( trans'ura! in2ury
Circu'ferentia! vs> !oca!ied in2ury
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Caustic Ingestion B!each ingestion
#
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Caustic Ingestion @oa!
0reventing per'anent
in2ury or stricture in
esophagus
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Caustic Ingestion Di!ution
8ater or 'i!&
3eutra!iing su/stancescontraindicated Eother'ic reaction
Ana!gesics
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Caustic Ingestion Anti/iotics 0ro
Decrease /acteria! counts 6eduction in granu!ation
Con In?u of gra' negatives Mas& infection 3o reduction in strictures
A'pici!!in ( #$ 'g4&g4day
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Caustic Ingestion Steroids
Meti! 0redniso!one ( : 'g4&g4day :9 days then taper
Most eective for grade : in2uries
Strictures easier to 'anage Anderson ( no /ene5t
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Caustic Ingestion 0revention of acid re?u
H: /!oc&ers
0roton pu'p inhi/itors
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Caustic Ingestion +athyrogens
0revent cova!ent cross
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Caustic Ingestion 3asogastric tu/e
Esophagea! stent
0revent adherence of anterior andposterior "a!!s of esophagus
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Caustic Ingestion Strictures deve!op in 9$
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Caustic Ingestion 0rograde di!ation
ac&son si!&
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Caustic Ingestion 6etrograde di!ation
Safer1Tuc&er di!ators
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Caustic Ingestion @runtig /a!!oon catheter
6adia! direction of di!ation
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Caustic Ingestion
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Caustic Ingestion Esophagea! rep!ace'ent
Co!onic interposition
e2una! interposition
@astric pu!!
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Caustic Ingestion Esophagea! carcino'a
9,$$$ increased ris&
9 to *9 years after in2ury
Better prognosis than usua!esophagea! cancer
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Caustic Ingestion
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Foreign Bodies Foreign /ody ingestion
Foreign /ody aspiration
Todd!ers .ra! ep!oration
+ac& posterior dentition
Easy distracti/i!ity
Cognitive deve!op'ent Gedi/!e1
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Foreign Body Ingestion Coins ( *#
Meat
egeta/!e 'atter
+ess than :; hours in 'ost
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Foreign Body Ingestion 0arenta! suspicion
Sy'pto's Cho&ing, coughing, dysphagia,
odynophagia
0hysica! ea' Droo!ing, refuses p>o>, fussy chi!d
6espiratory co'pro'ise
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Foreign Body Ingestion Co''on !ocations
Cricopharyngeus
Aorta4!eft 'ainste' /ronchus @astroesophagea! 2unction
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Foreign Body Ingestion 6adiopaue
Coins
Carti!age4/ones
6adio!ucent Hot dogs
Bariu' s"a!!o"
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Foreign Body Ingestion Bariu' S"a!!o"
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Foreign Body Ingestion ./servation
6ecent ingestion
B!unt o/2ect Endoscopy
Co'p!ete o/struction Air"ay co'pro'ise
I'pacted Caustics Ano'a!ies
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Foreign Body Ingestion
6e'ova! @enera! anesthesia
Intu/ated
Esophagoscopy Ea'ine for u!ceration4perforation
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Foreign Body Ingestion Disc /atteries
E'ergency
3a.H, K.H, 'ercury 9 hour ( 'ucosa! da'age : to ; hours ( 'uscu!ar !ayers = to 9: hours ( perforation
Esophagoscopy ./servation for gastric !ocation for ;
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Foreign Body Ingestion 0ostoperative 'anage'ent
30. for ;
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Foreign Body Ingestion Ba!!oon Catheter Etraction
Eective in J$
Endoscopy for fai!ures Co'p!ications
E'esis EpistaisTrachea! p!ace'ent +aryngospas' Air"ay co'pro'ise
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Foreign Body Aspiration Freuent!y resu!ted in death prior to :$th
century
@ross /ronchoto'y in a!! casesL Ki!!ian ( 9=J* ( 9st/ronchoscopic
re'ova! of foreign /ody Ear!y 9J$$s ( dista! i!!u'ination ac&son ( revo!utionied 5e!d of
/ronchoesophago!ogy 9J*$s ( rod !ens te!escopes
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Foreign Body Aspiration egeta/!e 'atter in *$
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Foreign Body Aspiration Bronchi ( =$
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Foreign Body Aspiration History
Cho&ing @agging 8heeing Hoarseness Dysphonia
Can 'i'ic asth'a, croup, pneu'onia
A positive history 'ust never /eignored, "hi!e a negative history 'ay /e'is!eadingL
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Foreign Body Aspiration Cho&ing episode "ith coughing, gagging
or "heeing Asy'pto'atic interva!
:$
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Foreign Body Aspiration 0hysica! ea'
+aryn4cervica! trachea Inspiratory or /iphasic stridor
Intrathoracic trachea 0ro!onged epiratory "heee
Bronchi neua! /reath sounds Diagnostic triad < %#$
ni!atera! "heee Cough Ipsi!atera!!y di'inished /reath sounds
Fi/eroptic !aryngoscopy
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Foreign Body Aspiration 6adiography
0A 7 !atera! vie"s of chest 7 nec&
Inspiration 7 epiration +atera! decu/itus vie"s
Air"ay ?uoroscopy
:# have nor'a! radiography
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Foreign Body Aspiration
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Foreign Body Aspiration
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Foreign Body Aspiration
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Foreign Body Aspiration
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Foreign Body Aspiration
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Foreign Body Aspiration@oa!
0ro'pt endoscopic re'ova! underconditions of 'ai'a! safety and'ini'a! trau'a
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Foreign Body Aspiration Co'p!ete air"ay o/struction
6espiratory distress
Ina/i!ity to spea& or cough 0artia! air"ay o/struction
Coughing
@agging
Throat c!earing
Bac& /!o"s4pro/ing hypopharyn notreco''ended
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Foreign Body Aspiration Co'p!ete air"ay o/struction
% one year Bac& /!o"s
) one year @ent!e a/do'ina! thrusts "hi!e supine
.!der chi!dren4adu!ts Hei'!ich 'aneuver
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Foreign Body Aspiration
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Foreign Body Aspiration sua!!y 3.T A DI6E EME6@E3CN
Trained personne!
Instru'ents asse'/!ed and chec&ed A"ait for e'ptying of sto'ach
Find dup!icate FB to test instru'ents
and techniues
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Foreign Body Aspiration @enera! anesthesia
Spontaneous venti!ation
+aryngoscopes Bronchoscopes
Suction
Forceps
6od
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Foreign Body Aspiration 6eady to assu'e air"ay during
induction
+aryngoscopy Ea'ination of upper air"ay Atrau'atic insertion of /ronchoscope
Topica! anesthesia Bronchoscopy
Attached to venti!ating circuit
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Foreign Body Aspiration Bronchoscopy
Suction opposite /ronchus
Advance to foreign /ody Atrau'atica!!y grasp foreign /ody
6epeat /ronchoscopy Suction /ronchus
Mu!tip!e foreign /odies in #
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Foreign Body Aspiration
S!ipped foreign /ody 0ush /ac& into /ronchus
Sharp foreign /ody Advance /ronchoscope over FB
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Foreign Body Aspiration
Co'p!ications 0neu'onia
Anti/iotics, physiotherapy Ate!ectasis
Epectant 'anage'ent, physiotherapy
0neu'othora 0neu'o'ediastinu'
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Foreign Body Aspiration
0ostoperative Care Chest physiotherapy for retained
secretions Anti/iotics
3ot routine!y used
Steroids 3ot routine!y usedTrau'atic insertion or re'ova!
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