Foreign bodies Flashcards
List the most common places kids get FB
Nose
Mouth - portal into the GI system or Resp
Ears
Sometimes
Vagina
Rectum
Urethra
What are the most common Sx of an impacted esophageal FB?
Asymptomatic (50%) FB sensation Gagging Vomiting Drooling Dysphagia Refusal to eat and drink Choking Coughing Stridor Wheezing Increased WOB
Where do FB impact in the esophagus?
At the level of the cricopharyngeus muscle (most common)
Esophageal sphincter
Level of the Aortic Arch (less likely)
Congenital anatomic narrowings
What are the most common esophageal FBs?
Coins! (pennies being most common)
How to manage an impacted esophageal coin?
Expectant management in ASxmtc kids is ok
Spontaneous passage in 30% of ASxmtc kids
Wait 24h and kid can eat and drink normally
Obtain F/U CXR to see if coin passes the esophageal sphincter
RTED if develops Signs/Sxs of esophageal obstruction or resp distress
Is there a medication to encourage passage of a coin in the esophagus?
IV Glucagon
Can offer PO intake to see if that moves it - this is only concerning if it does not pass and removal is needed - impacts the NPO status
How should impacted esophageal FBs be removed?
Often by flexible endoscopy (by GI)
How can you tell a button battery from a coin
AP XR - double ring
Lateral XR - double bump
How button batteries cause injury so quickly when impacted?
Moist environment of the esophagus combined with the electric current causes hydrolysis and hydroxide build up and local corrosive injury
What are the risk of FB ingestion after it passes into the stomach?
Minimal is small and blunt
Multiple magnets are concerning - need FU XR +/- intervention
Small (<5 cm) sharp objects pose minimal risk
Disc batteries in the stomach - need FU XR:
- if the patient becomes Sxmtc
- if the patient is < 6 years with a 15 mm or larger battery
- weekly if the battery is not seen in the stool
Things that need removal
- Multiple magnets
- Large button batteries > 15 mm in young kids ( <6 years) that have not passed from the stomach in 48h
- Quarters that do not pass from the stomach in 3-4 weeks
When should sharp FBs be removed?
If in the stomach or above and > 5 cm
If < 5 cm most pass without complication
Touch base with GI for removal
Most FB (small nails, pins, tacks, staples) will pass spontaneously
RTED if Sxmtc (abdo pain, distention, vomiting, bloody stools etc.)
What is the classic triad of a FB aspiration?
Cough
Wheezing
Unilateral decreased breath sounds
1/3 of kids have this
More likely to be present the longer the FB has been in place
Most present ASxmtc and 20% have normal PEx
What are the most common FBs aspirated?
Foodstuffs:
- Nuts (most common)
- Apples
- Carrots
- Seeds
- Popcorn
Can also be
- pen caps
- earrings
- crayons
- springs from pens
- lint
- chalk
Only 15% are radiopaque
List the signs and symptoms of an aspirated FB
Resp distress Decreased breath sounds Stridor Wheezing Crackles Cough FB sensation Asxmtc
What are some XR findings in a FB aspiration?
Normal
Opacity to one side
Air trapping on inspiratory and expiratory views
Failure to deflate on the dependent (downturned) side on lateral/recumbent XR
