Corroded
Gastrointestinal System
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S9_F1.jpg"}},{"insert":"\n\n"},{"insert":"\u0022Did you hear about the little boy they just brought in? Swallowed some drain cleaner while the mother was off drinking somewhere\u0022, you overhear one nurse telling another, as you pass them in the corridor.\n\nYou only catch part of the second nurse\u0027s reply, as you enter the ER to start your shift.\n\n\u0022Honestly! Mothers these da...\u0022\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S9_F2.jpg"}},{"insert":"\n\n"},{"insert":"In the ER, you find yourself being introduced to the subject of the nurses\u0027 conversation: 12 year old Aaron, who accidentally swallowed some drain cleaner around 15 minutes ago.\n\nHis tearful mother says that she filled an empty bottle of fruit juice with drain cleaner borrowed from a neighbour and left it on the kitchen counter, while going off to clean the rest of the house.\n\nUpon returning from school, her son noticed the bottle, and took a deep swig ....\n\nAaron\u0027s mother appears terrified, and you cannot help but notice that she looks rather unkempt.\n\nAs you catch the faint smell of alcohol on her breath, you wonder if the nurses were right after all ...\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S9_F3.jpg"}},{"insert":"\n\n"},{"insert":"On examination, you note that Aaron has multiple chemical burns around his mouth, and that some drain cleaner appears to have fallen on his clothes as well.\n\nHis vital parameters are currently stable, with a blood pressure of 110\/70 mmHg, pulse rate of 92 bpm, and respiratory rate of 24 cycles\/min.\n\nHe is currently on 60% oxygen via a face mask. His oxygen saturation is 94%.\n\nA detailed examination reveals extensive chemical burns of the lips, tongue and oral mucosa. However, his pharynx does not appear to be edematous.\n\nHis breathing appears to be somewhat labored, and you notice the presence of stridor.\n\nAaron\u0027s mother is almost hysterical now, and you have no option but to courteously ask her to take a seat outside.\n\nThe nurse in charge asks you whether she should prepare Aaron for an endoscopy.\n\nYou find yourself in two minds. Should you intubate Aaron first? Or is it better to wait until the endoscopy has been completed?\n"}]}
3
{"ops":[{"insert":"What do you do now?\n"}]}
1. Intubate Aaron first
2. Hold off intubation until endoscopy has been performed
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