A 5-year-old child ingested an unknown quantity of caustic drain cleaner approximately 15 minutes ago. On arrival, the child is crying, has burns around the mouth, and is drooling profusely. Which of the following is the most appropriate initial intervention?
- AAdminister activated charcoal to absorb the cleaner.
- BAdminister milk or water to dilute the substance.
- CInduce vomiting with syrup of ipecac.
- DMaintain airway patency and transport immediately.
Show answer & explanationAnswer & explanation
Correct answer: D. Maintain airway patency and transport immediately.
The ingestion of caustic substances like drain cleaner is a medical emergency. The priority is to maintain a patent airway, especially given the drooling (indicating potential laryngeal edema or inability to swallow), and transport immediately. Inducing vomiting or giving activated charcoal is contraindicated due to the risk of re-exposure, aspiration, or further damage. Dilution with milk or water is controversial and generally not recommended in the prehospital setting due to aspiration risk and potential to delay definitive care.
Why the other options are wrong
- A. Activated charcoal does not bind to caustic substances effectively and is therefore contraindicated.
- B. While historically used, administering milk or water for dilution is controversial, carries an aspiration risk, and may induce vomiting, worsening injury. It is generally not recommended prehospital.
- C. Inducing vomiting is contraindicated in caustic ingestions due to the risk of re-exposing the esophagus and airway to the corrosive substance and increasing aspiration risk.
Caustic Ingestion Management
Management of caustic ingestion prioritizes airway protection and rapid transport to a hospital for endoscopy. Vomiting induction and activated charcoal are contraindicated due to risk of re-injury and aspiration.
- Do NOT induce vomiting.
- Do NOT administer activated charcoal.
- Focus on airway management, pain control, and rapid transport.
- Burns around mouth and drooling indicate significant injury.
Memory trick: Caustic Chemical: Clear Airway, Control Pain, Carry Quickly.