A paramedic is called to a residence for a 4-year-old child who has ingested an unknown quantity of household cleaner. The child is crying, has burns around the mouth, and is drooling. What is the MOST critical prehospital intervention for this patient?
- AInduce vomiting using syrup of ipecac.
- BAssess and maintain a patent airway.
- CAdminister activated charcoal orally.
- DAdminister milk to dilute the ingested substance.
Show answer & explanationAnswer & explanation
Correct answer: B. Assess and maintain a patent airway.
In caustic ingestions, the most immediate life threat is airway compromise due to swelling and burns to the oropharynx and larynx. Drooling and crying are signs of potential airway obstruction. Therefore, assessing and maintaining a patent airway is the absolute priority. Activated charcoal and inducing vomiting are contraindicated in caustic ingestions, and milk for dilution is secondary to airway management.
Why the other options are wrong
- A. Inducing vomiting is contraindicated in caustic ingestions due to the risk of re-exposure of the esophagus to the caustic substance and potential aspiration.
- C. Activated charcoal is generally contraindicated in caustic ingestions as it does not bind caustics and can obscure endoscopic views.
- D. While dilution (e.g., with water or milk) may be considered, airway management takes precedence, and forced dilution could induce vomiting or aspiration.
Caustic Ingestion Airway Management
Caustic ingestions can cause severe burns to the upper airway and esophagus, leading to rapid swelling and airway compromise. The primary prehospital concern is to assess and secure a patent airway before addressing other interventions.
- Caustic substances cause chemical burns.
- Airway swelling/burns are immediate life threats.
- Drooling, stridor, hoarseness indicate airway compromise.
- Activated charcoal and inducing vomiting are contraindicated.
Memory trick: Caustic: Airway First, Don't Make Them Puke!