NREMT Paramedic Cognitive ExamOperationsMedium
A paramedic is assessing a 4-year-old child who ingested an unknown quantity of household cleaning product. The child is crying, has burns around the mouth, and is drooling excessively. Vomiting has occurred once. What is the MOST critical immediate intervention for this patient?
- AAdminister activated charcoal to absorb the toxin.
- BEnsure airway patency and assess for respiratory compromise.
- CInduce vomiting to remove the ingested substance.
- DAdminister milk to dilute the ingested cleaning product.
Show answer & explanationAnswer & explanation
Correct answer: B. Ensure airway patency and assess for respiratory compromise.
Caustic ingestions can cause severe burns to the airway and esophagus, leading to swelling and respiratory compromise. The excessive drooling and burns around the mouth suggest significant irritation and potential airway edema. Ensuring airway patency is always the highest priority in any emergency, especially with potential airway burns.
Why the other options are wrong
- A. Activated charcoal is generally contraindicated for caustic ingestions as it can obscure endoscopic views and is ineffective against caustics.
- C. Inducing vomiting is absolutely contraindicated in caustic ingestions due to the risk of re-exposing the esophagus to the caustic substance and causing further damage or aspiration.
- D. Administering milk or water to dilute caustics is generally discouraged as it can induce vomiting and worsen burns, and may delay definitive treatment.
Caustic Ingestion Management
Emergency care for patients who have ingested corrosive substances, focusing on airway protection, avoiding further harm, and rapid transport for definitive evaluation.
- Airway management is paramount due to potential edema/burns.
- Do NOT induce vomiting.
- Do NOT administer activated charcoal.
- Avoid dilution with milk/water unless specifically advised by poison control.
Memory trick: Caustic Airway First, No Puke, No Charcoal.