Decontaminate first: use appropriate personal protective equipment, remove all patient's clothing, decontaminate patient
Irrigate areas of dermal or ocular exposure, early and copiously!
Airway management
Monitor closely for stridor, airway edema, hoarseness, or other signs of airway injury
Intubate early if signs of airway injury exist, before airway becomes more difficult to manage.
Consider awake fiberoptic or video laryngoscopy if concern for difficult airway
Blind nasotracheal intubation is contraindicated in caustic ingestion due to the potential for perforations and false passages
Bronchodilators for bronchospasm if concern for inhalational injury
Monitor closely for stridor, airway edema, hoarseness, or other signs of airway injury
Intubate early if signs of airway injury exist, before airway becomes more difficult to manage.
Consider awake fiberoptic or video laryngoscopy if concern for difficult airway
Blind nasotracheal intubation is contraindicated in caustic ingestion due to the potential for perforations and false passages
Bronchodilators for bronchospasm if concern for inhalational injury
Metabolic<unk> osis: consider bicarbonate for severe<unk> osis
Severe hemolysis may require exchange transfusion
Airway management especially important!
Endoscopy
Indications:
All intentional ingestions (higher likelihood of high volume ingestion)
Any ingestion with stridor, drooling, significant oropharyngeal burns, vomiting, food refusal
Perform within 12-24 hours of ingestion (too early can underestimate extent of injury, too late increases risk of wound softening and perforation)
Esophageal stricture mitigation
Discuss with GI or toxicologist
Grade IIb or higher esophageal burns: Methylprednisolone (1 g/1.73 m2 per day for 3 days), ranitidine, ceftriaxone, total parenteral nutrition
Surgical intervention: indicated if perforation or peritoneal signs
Contraindicated (or controversial) therapies:
Antibiotics (unless giving steroids]]
Activated charcoal (may consider when coingestants pose a risk for severe systemic toxicity)
Gastric lavage: contraindicated due to potential to cause reflux of caustic agent into esophagus, creating more damage
Dilution with water or milk: causes vomiting, elevating risk for perforation
Neutralization (e.g. with milk or mag citrate): generates excess heat
Indications:
All intentional ingestions (higher likelihood of high volume ingestion)
Any ingestion with stridor, drooling, significant oropharyngeal burns, vomiting, food refusal
Perform within 12-24 hours of ingestion (too early can underestimate extent of injury, too late increases risk of wound softening and perforation)
All intentional ingestions (higher likelihood of high volume ingestion)
Any ingestion with stridor, drooling, significant oropharyngeal burns, vomiting, food refusal
Discuss with GI or toxicologist
Grade IIb or higher esophageal burns: Methylprednisolone (1 g/1.73 m2 per day for 3 days), ranitidine, ceftriaxone, total parenteral nutrition
Antibiotics (unless giving steroids]]
Activated charcoal (may consider when coingestants pose a risk for severe systemic toxicity)
Gastric lavage: contraindicated due to potential to cause reflux of caustic agent into esophagus, creating more damage
Dilution with water or milk: causes vomiting, elevating risk for perforation
Neutralization (e.g. with milk or mag citrate): generates excess heat
Eye irrigation
Immediate irrigation is the most important treatment for caustic ocular injury, and should be started before comprehensive evaluation
Irrigate affected eye(s) with copious amounts of fluid (no consensus on volume or length of time)
NS, LR, or BSS (Buffered Saline Solution) preferred in the hospital setting, but tap water is acceptable, especially in pre-hospital setting.
Goal is to remove caustic agent and restore normal ocular pH (7.0-7.2)
Do NOT attempt to neutralize pH by adding base to an<unk> ic burn or<unk>  to an alkali burn
Use of morgan lens or eyelid speculum will assist with getting more fluid in contact with cornea
Remove particulate matter
Evert both lids, remove any visible particulate matter with cotton-tipped applicator
Anesthesia
Topical anesthetic (e.g. tetracaine) to help with discomfort.
Other options include cycloplegics (e.g. atropine, cyclopentolate), IV/IM/PO analgesics
Antibiotics
Erythromycin ophthalmic ointment QID for minor burns
Topical fluoroquinolone for more severe burns
Control inflammation
Topical steroids - prednisolone 1% ophthalmic QID for 1 week
Limit topical steroid use to 10 days to avoid corneal breakdown.
Ophthalmology consultation for all but minor burns (Severe exposures may require debridement or other surgical intervention)
Immediate irrigation is the most important treatment for caustic ocular injury, and should be started before comprehensive evaluation
Irrigate affected eye(s) with copious amounts of fluid (no consensus on volume or length of time)
NS, LR, or BSS (Buffered Saline Solution) preferred in the hospital setting, but tap water is acceptable, especially in pre-hospital setting.
Goal is to remove caustic agent and restore normal ocular pH (7.0-7.2)
Do NOT attempt to neutralize pH by adding base to an<unk> ic burn or<unk>  to an alkali burn
Use of morgan lens or eyelid speculum will assist with getting more fluid in contact with cornea
Evert both lids, remove any visible particulate matter with cotton-tipped applicator
Topical anesthetic (e.g. tetracaine) to help with discomfort.
Other options include cycloplegics (e.g. atropine, cyclopentolate), IV/IM/PO analgesics
Erythromycin ophthalmic ointment QID for minor burns
Topical fluoroquinolone for more severe burns
Topical steroids - prednisolone 1% ophthalmic QID for 1 week
Limit topical steroid use to 10 days to avoid corneal breakdown.
Hydrochloric acid
Caustic ingestion
Hydrofluoric acid
Caustic eye exposure 
Agent orange
Caustic dermal burn
Selenium sulfide
Airbag-related burns