Prevent provider and continued patient exposure to the<unk>  agent by removing all clothing and decontaminating the patient
There is a possible benefit of water ingestion immediately after ingestion of a powdered<unk>  to irrigate adherent materials in oropharynx/esophagus if no airway concerns to prevent prolonged injury from the powder adhering to tissues
Monitor closely for stridor, airway edema, hoarseness, or other signs of airway injury
Intubate early if signs of airway injury exist, first sign of voice changes, inability to tolerate secretions or stridor before airway becomes more difficult to manage.
Consider awake fiberoptic or video laryngoscopy if concern for difficult airway
Blind nasotracheal intubation is contraindicated due to the potential for perforations and false passages
Should be performed in the first 24 to 48 hours after ingestion (too early can underestimate extent of injury, too late increases risk of wound softening and perforation).
Intentional ingestion (higher likelihood of high volume ingestion)
Unintentional ingestion with signs of:
Stridor
Significant oropharyngeal burns
Vomiting
Drooling
Food refusal
Stridor
Significant oropharyngeal burns
Vomiting
Drooling
Food refusal
Discuss with GI or medical toxicologist
For grade IIb or higher esophageal burns:
Methylprednisolone (1 g/1.73 m2 per day for 3 days)
Ranitidine
Ceftriaxone
Total parenteral nutrition
Sucralfate, Mitomycin C
Methylprednisolone (1 g/1.73 m2 per day for 3 days)
Ranitidine
Ceftriaxone
Total parenteral nutrition
Indicated for:
Perforation
Peritoneal signs
Perforation
Peritoneal signs
Can include chelation, dialysis, or specific antidotes
Especially in<unk> s that cause systemic toxicity
Especially in<unk> s that cause systemic toxicity
Antibiotics
No evidence to support or reject the use of prophylactic antibiotics
Only indicated if also giving steriods (see stricture mitigation above)
Activated charcoal
May infiltrate damaged mucosa & interfere with EGD
Only consider when coingestants pose a risk for severe systemic toxicity
Zinc chloride and mercuric chloride systemic absorptions may outweigh interference with endoscopy
Gastric lavage
Contraindicated due to potential to cause reflux of<unk>  agent into esophagus, creating more damage
Blind nasogastric-tube insertion for irrigation can cause thermal injury through neutralization
Dilution with water or milk causes vomiting, elevating risk for perforation
Possible benefit only for solid alkali ingestions
Neutralization generates excess heat
Milk or magnesium citrate only for hydrofluoric acid ingestion
No evidence to support or reject the use of prophylactic antibiotics
Only indicated if also giving steriods (see stricture mitigation above)
May infiltrate damaged mucosa & interfere with EGD
Only consider when coingestants pose a risk for severe systemic toxicity
Zinc chloride and mercuric chloride systemic absorptions may outweigh interference with endoscopy
Contraindicated due to potential to cause reflux of<unk>  agent into esophagus, creating more damage
Blind nasogastric-tube insertion for irrigation can cause thermal injury through neutralization
Possible benefit only for solid alkali ingestions
Milk or magnesium citrate only for hydrofluoric acid ingestion
Caustic ingestion
Laundry detergent pod ingestion
Caustic eye exposure 
Hymenoptera stings
Caustic dermal burn
Lightning injuries
Airbag-related burns
Neurotoxic shellfish poisoning