NREMT Paramedic Cognitive ExamMedicalHard
A 5-year-old child ingested an unknown quantity of caustic drain cleaner approximately 15 minutes ago. On arrival, the child is crying, has significant oral burns, and is drooling profusely. Which of the following is the most appropriate initial action?
- AInduce vomiting to remove the ingested substance.
- BAdminister activated charcoal to absorb the chemical.
- CAdminister milk or water to dilute the substance.
- DAssess the airway and provide supportive care.
Show answer & explanationAnswer & explanation
Correct answer: D. Assess the airway and provide supportive care.
The child's symptoms (oral burns, drooling) indicate significant caustic injury, and airway compromise is a critical and immediate threat due to swelling. Inducing vomiting or administering activated charcoal is contraindicated for caustic ingestions due to the risk of further injury. While dilution may be considered in some cases, the most immediate priority is always airway assessment and management, followed by supportive care.
Why the other options are wrong
- A. Inducing vomiting is contraindicated in caustic ingestions as it can cause re-exposure of the esophagus and pharynx to the corrosive substance, leading to further damage.
- B. Activated charcoal is ineffective for caustic agents and can obscure endoscopic visualization of the injury, so it is contraindicated.
- C. While dilution with small amounts of milk or water might be considered for very recent, minor ingestions, it is not the immediate priority when there are signs of significant oral burns and drooling, which indicate potential airway compromise. Excessive fluid can also induce vomiting or worsen swelling.
Caustic Ingestion Management
Emergency care for ingestion of corrosive substances, focusing on airway protection and avoiding interventions that cause further harm.
- Airway assessment and management are paramount
- Do NOT induce vomiting or administer activated charcoal
- Avoid excessive dilution; consider small sips of water/milk only if minor and very recent
Memory trick: Airway First, No Vomit, No Charcoal!