(Click here to return to the Pediatric
Surgery @ Brown Home Page)
|These pages are excerpted from the Trauma
Resident Handbook, Rhode Island Hospital Department of Surgery,
Division of Trauma - updated 2001. The policies herein are intended
to serve as guidelines only. Individual circumstances need to
be considered as there may be times when it is appropriate or
desirable to deviate from these guidelines. These educational
guidelines will be reviewed and updated routinely.
All pediatric patients with caustic burns to the esophagus
or oropharynx will be treated jointly by Pediatric Surgery and
Pediatric Gastroenterology. Either service may serve as the admitting
service, with the other following the patient in consultation.
- Stabilization of airway by either emergency
physician or trauma surgeon. ENT consult to evaluate the extent
of pharyngeal injury via flexible laryngoscopy when severe airway
manifestations (e.g., stridor) are present.
- Indications for immediate EGD include airway
symptoms (e.g., stridor), spontaneous vomiting, significant pain,
and buccal mucosal lesions. Patients with active psychiatric
disorders can be difficult to assess and should be strongly considered
for endoscopy on an independent basis.
- Asymptomatic patients can be observed in
the ED for 6 hours and then reevaluated for progression of symptoms.
- Steroids for patients with airway edema and
gastrointestinal second- and third- degree burns. During therapies
to follow steroid use include prophylactic antibiotic coverage
for anaerobic organisms (e.g., penicillin) and H2 antagonists.
- Diagnostic studies to include plain radiographs
(soft tissue neck, chest, upright abdomen, and KUB), oral contrast
swallow (for perforations), and CT chest (for mediastinitis).
- Notify services upon patients arrival.
here to return to Hasbro Children's Hospital Surgery Handbook