The tactics of treating an esophageal burn depend on many factors: the degree of the burn and the clinical form, the time, the effectiveness of first aid or the arrival of the victim in the emergency room, the amount, concentration and properties of the caustic liquid (acid, alkali, etc.) that caused the injury .
According to good clinical practice, the treatment of chemical burns of the esophagus is divided into an acute stage (between the first and ten days after the burn), an initial subacute (10-20 days), and then a stage with chronic post-burn esophagitis (after 30 days).
First aid for burns of the esophagus
Emergency treatment in a hospital is divided into local and general, includes the appointment of injectable analgesics, antihistamines and antidotes that help neutralize aggressive fluids. In case of alkali poisoning, the victim is recommended to use weak solutions of acids (acetic, citric, tartaric), beaten egg white. In case of acid poisoning, magnesium oxide, a solution of baking soda (a teaspoon per half a glass of warm boiled water), a protein mixture – four beaten egg whites per half a liter of warm boiled water, mucous decoctions can be used. These funds are ineffective four hours after poisoning, since the burn of the esophagus develops as quickly as possible. Rather, they are aimed at neutralizing and binding the toxic fluid that has entered the stomach and possibly further into the intestines.
For sorption of toxic substances in the gastrointestinal tract, activated charcoal is used, which is mixed with water and taken before and after gastric lavage.
With common intoxication phenomena, forced diuresis of osmotic diuretics (urea, mannitol) or saluretics (lasix, furosemide) is carried out, which contributes to a sharp increase in diuresis, due to which the removal of toxic substances from the body is accelerated several times.
The method is indicated for most intoxications with primary elimination of toxic substances by the kidneys. It consists of the following procedures (performed in sequence): water loading, intravenous diuretics, and compensation with electrolyte solutions. Hypovolemia, which develops in severe poisoning, is stopped by intravenous drip injection of plasma-substituting solutions (hemodez and a five percent glucose solution in a volume of up to one and a half liters) for an hour or two.
Urea (2 g/kg of the patient’s weight) is administered intravenously in a 30% or 15% mannitol solution for 15 minutes, furosemide – at a dose of up to 200 mg. At the end of the administration of the diuretic, an intravenous infusion of an electrolyte solution is performed (5 g of potassium chloride, 6 g of sodium chloride, 10 g of glucose per 1 liter of solution). If necessary, the cycle of these measures is repeated after five hours, until the toxic substance is completely removed from the blood. It should be borne in mind that a part of the toxic substance may be in the parenchymal organs, causing their dysfunction, therefore, it is advisable to carry out appropriate symptomatic treatment. The volume of the injected solution should correspond to the amount of urine excreted from the body, approximately 1,2 liters per hour.
If there are signs of pain shock, anti-shock measures are taken, including analgesics, blood pressure is restored with intravenous administration:
- blood;
- plasma;
- glucose;
- blood substitutes.
Early treatment is carried out after the acute period in order to reduce the likelihood of scarring of the esophagus. Treatment begins in the so-called “hot” gap after a burn, when the reaction and inflammation decreased to a minimum, the body temperature returned to normal, the patient’s condition improved, and dysphagia was minimized or disappeared altogether.
Bougienage method
The bougienage procedure is performed by introducing special instruments (bougie) into some tubular organs (esophagus, auditory tube, urethra, etc.) to expand them. Typically, bougienage of the esophagus in adults is carried out using elastic cylindrical bougie with a conical tip under the control of esophagoscopy or metal bougie with olive oil.
A contraindication to the procedure is the presence of inflammatory processes in the oral cavity and pharynx (possibly infection of the esophagus).
The procedure is prescribed from the fifth to the fourteenth day after the burn. Previously, an X-ray examination of the esophagus is mandatory. According to some experts, it is advisable to use bougienage even in the absence of noticeable signs of initial stenosis of the esophagus, which further slows down and reduces the severity of subsequent stenosis.
Surgical treatment of post-burn stress of the esophagus is divided into palliative and pathogenetic. Palliative methods include gastrostomy, which is used if bougienage does not bring the desired result. Gastrostomy is used in the presence of esophageal atresia, scarring, fresh burns, etc.
Summing up
So, if there is an assumption or symptoms of a burn of the esophagus, it is urgent to call an ambulance or take the victim to a medical facility. Before the arrival of the ambulance, the patient must thoroughly rinse the stomach, give activated charcoal or another adsorbent, and also inject an anesthetic. The victim needs to relax and take a horizontal position. It is important to stop eating (you can drink water) and smoking, do not drink alcoholic beverages.
- Sources of
- Volkov, S.V. Complications of burn lesions of the esophagus of chemical etiology in conditions of complex therapy / S.V. – Volkov, E.A. Luzhnikov // Anesthesiology and resuscitation. – 1995. – No. 4. – With. 36-37.
- Klimashevich A.V., Nikolsky V.I., Nazarov V.A., Bogonina O.V., Shabrov A.A. The optimal method of bougienage of the esophagus in post-burn cicatricial strictures. Fundamental research. – 2013. – No. 3-1. – With. 88-91.