I have severe burning in my throat—what immediate steps should I take and when should I seek medical evaluation?

Severe Burning in Throat: Immediate Steps and When to Seek Medical Evaluation

If you have severe burning in your throat, immediately cool the area by drinking cold water or milk, and seek emergency medical evaluation if you have difficulty breathing, difficulty swallowing, facial burns, soot around your nose or mouth, or if the burning occurred after ingesting a caustic substance or extremely hot food/liquid. 1

Immediate First Aid Steps

For Thermal Burns (Hot Food/Liquid)

• Cool the burn immediately by drinking cold water or milk in small sips 1
• Continue cooling for 5 to 20 minutes if tolerated 1
• Do not induce vomiting if you ingested hot substances 1
• Take over-the-counter pain medications (acetaminophen or ibuprofen) for pain relief 1

For Suspected Chemical/Caustic Ingestion

• Do not induce vomiting as this can cause additional injury 1
• Rinse your mouth with water but do not swallow if a caustic substance was involved 1
• Contact Poison Control immediately to evaluate systemic toxicity of the ingested agent 1
• Seek emergency medical care without delay 1

When to Seek IMMEDIATE Emergency Medical Evaluation

You must activate emergency medical services (call 911) if you experience any of the following:

Critical Warning Signs

• Difficulty breathing or shortness of breath - this may indicate airway swelling that can rapidly progress to complete airway obstruction 1, 2
• Stridor (high-pitched breathing sound) or obstructed breathing pattern 1
• Difficulty swallowing or inability to swallow saliva 2, 3
• Facial burns, singed nasal hairs, or soot around nose or mouth - these indicate potential inhalation injury 1
• Severe chest pain developing after throat burning - this can rarely indicate serious conditions like aortic dissection 4
• Agitation or feeling of impending doom - never ignore a patient who complains of difficulty breathing, even if objective signs are initially absent 1

High-Risk Scenarios Requiring Emergency Evaluation

• Ingestion of caustic substances (drain cleaners, strong acids/alkalis, bleach, ammonia) - even if you have no oral lesions or minimal pain, severe internal injury can still be present 1
• Ingestion of extremely hot food or liquid with persistent severe pain - thermal epiglottitis can cause delayed fatal airway obstruction hours after the initial injury 2
• Burns involving the face, mouth, or anterior neck - these require early evaluation as extensive soft-tissue swelling can develop rapidly and complicate airway management 1, 5

When to Seek Urgent (Same-Day) Medical Evaluation

Seek medical evaluation within hours if you have:

• Persistent severe throat pain that is not improving with cooling and pain medication 1, 6
• Progressive symptoms - worsening pain, increasing difficulty swallowing, or new symptoms developing 1, 4
• Fever, increasing pain, or purulent discharge - these suggest infection 7
• Deep cervical pain, painful swallowing, or crepitus - these may indicate deeper tissue injury 1

Initial Medical Workup (What Healthcare Providers Will Do)

If you present to the emergency department, expect the following evaluation:

Laboratory Testing

• Complete blood count, electrolytes (sodium, potassium, chloride, magnesium, calcium), kidney and liver function tests 1
• pH and serum lactate levels - severe acidosis indicates transmural necrosis 1
• Blood alcohol level if ingestion circumstances are unclear 1

Imaging Studies

• Neck, chest, and abdominal radiographs may show free air if perforation has occurred 1
• Contrast-enhanced CT scan of neck, thorax, and abdomen should be performed 3-6 hours after caustic ingestion - this outperforms endoscopy in detecting transmural injuries and predicting complications 1
• The absence of post-contrast wall enhancement on CT indicates transmural necrosis requiring emergency surgery 1

Common Pitfalls to Avoid

• Do not assume absence of oral lesions means no serious injury - clinical symptoms do not correlate reliably with the extent of gastrointestinal damage after caustic ingestion 1
• Do not delay evaluation for thermal injuries - thermal epiglottitis can cause delayed fatal airway obstruction even hours after hot food ingestion 2
• Do not ignore evolving symptoms - patient presentation may change throughout the course of evaluation, and atypical presentations of serious disease can occur 4
• Monitor children for hypothermia if actively cooling with water 1

Special Considerations

For Hyperacidity-Related Burning

If your burning throat is chronic and associated with water brash (excessive salivation), this may represent gastroesophageal reflux disease, and 90% of such patients respond to antacids 6. However, severe acute burning requires immediate evaluation to rule out more serious causes first 1, 4.

Post-Injury Monitoring

• If you are kept for observation, you should be nursed upright and given high-flow humidified oxygen 1
• You should be kept NPO (nothing by mouth) as laryngeal competence may be impaired despite full consciousness 1
• Continuous monitoring of respiratory rate, oxygen saturation, and level of consciousness is essential 1