Poisoning

1. Management
of Caustic Injury
pharmacologic treatment
ACID AND ALKALI
POISONING
ACID AND ALKALI
POISONING
EMERGENCY
TREATMENT
Assessment: Particular attention should be
paid to the inability to control oral secretions or
a change in voice, indicating impending
airway compromise. If noted, intubation may
be required.
For potential skin and eye injury: Clothing
should be removed and exposed, and the skin
irrigated with copious amounts of water.
Immediate irrigation of the eyes is indicated
when ocular exposure is suspected.
For alkali injuries caused by ingestion,
immediate dilution with drinking a glass of
water for prehospital setting.
Fluid resuscitation if often indicated. Central
venous access may be necessary for refractory
shock and accurate blood pressure monitoring.
Profound hypovolemia may develop (as in the
setting of a significant thermal burn) and should
be treated with crystalloid, colloid, or blood
products when indicated.
a guide to first-aid
Caustics (strong acids and alkalis), when ingested,
burn upper gastrointestinal tract tissues, sometimes
resulting in esophageal or gastric perforation. While
they serve essential purposes, they can also pose
significant risks when mishandled or accidentally
ingested. Acid and alkali poisoning occurs when these
substances come into contact with the body,
Understanding how to respond in these situations is
vital for everyone's safety.
WHAT NOT TO DO?
gastric lavage
Risk of Perforation. Immediate lavage within 1-
2 hours after large volume of ingestion is
beneficial.
emesis
leads to new exposure and risk of aspiration
neutralization
leads to heat production thus more injury
activated charcoal
obscures endoscopic view
Remember CALMS. Corticosteroid, Antibiotics,
Lathyrogenic agents, Mitomycin, Sucralfate
Micah B. Abainza
BSN 4 RLE Group 1

2. Airway
RECOMMENDED
TREATMENT
AVOID any attempts at gastric lavage,
activated charcoal or attempted
dilution/neutralization.
These can worsen injury as emesis causes
corrosive agents to be re-exposed to
esophagus.
Decontamination
Excretion:
BURNS DIFFICULTY
SWALLOWING
SKIN & EYE
IRRITATION
PAIN
NAUSEA &
VOMITING
DIFFICULTY
BREATHING
COMMON
SIGNS &
SYMPTOMS
COMMON
SIGNS &
SYMPTOMS
ACIDS
Acids are substances
that have a pH level
below 7. They typically
release hydrogen ions
(H+) when dissolved in
water, making them
corrosive and capable of
causing burns and
damage to living
tissues.
Acids cause coagulation
necrosis; an eschar
forms, limiting further
damage. Acids tend to
affect the stomach more
than the esophagus.
Consider the need for immediate airway
intervention (assess for stridor, hoarseness,
respiratory distress, drooling or inability to
handle secretions).
Consider early intubation.
Video laryngoscopy preferred to minimize
manipulation.
Nebulized epinephrine can be used during
set-up if stridor present.
Consider larger tube size if significant
hypoxemia (bronchoscopy may be required).
Any dermal exposures: remove clothing, wash
with soap and water.
Ocular exposures require irrigation with
minimum 2L NS until pH is within normal limits
(once globe perforation is ruled out).
are substances that have
a pH level above 7.
They release hydroxide
ions (OH-) when
dissolved in water and
can also be corrosive,
causing burns and
tissue damage.
Alkalis cause rapid
liquefaction necrosis; no
eschar forms, and
damage continues until
the alkali is neutralized
or diluted. Alkalis tend
to affect the esophagus
more than the stomach,
ALKALIS
WHAT ARE THEY?
COMMON CAUSTIC
SUBSTANCES AND ITS USE
Both acid and alkali
causes burns, both
internally (if ingested)
and externally (if in
contact with the skin
or eyes). These burns
can be painful and
may appear as
redness, blistering, or
tissue damage.
One may
experience intense
pain, particularly
in the mouth,
throat, chest, or
abdomen if the
acid/alkali was
ingested.
Acid exposure can
lead to difficulty
swallowing due to
throat irritation and
inflammation. This
symptom can be
accompanied by
hoarseness or a sore
throat.
Acid ingestion
may result in
nausea and
vomiting as the
body's natural
response to expel
the harmful
substance.
Inhaling alkali
fumes or vapors can
lead to respiratory
distress, causing
symptoms like
coughing, shortness
of breath, and chest
discomfort.
Alkali contact with
the skin or eyes
can result in
irritation, redness,
and discomfort.
Eye exposure can
be particularly
dangerous and
may lead to vision
problems.
In general, acids with a pH of less than 2 and alkalis
with a pH of more than 12 cause the most extensive injury.