Foreign body Flashcards
What should be asked about in terms of ear foreign bodies?
Pain
Discharge from the ear
Hearing loss
What should be asked about in terms of nose foreign bodies?
Breathing issues
Nasal discharge
What should be asked about in terms of ingested foreign bodies?
Nature of the object - sharp or soft
Dysphagia
Able to swallow saliva?
What should happen to live insects in the ear?
Drowned with oil
What does examination of a FB depend on?
Location
How are nose FBs examined?
Age appropriate thudicum speculum and a head torch or otoscope
How are ear FBs examined?
Direct visualisation by otoscopy
How are FBs in the pharynx visualised?
Lacks tongue depressor and head torch Palpate for points of neck tenderness See if these points move with swallowing Feel for surgical emphysema Flexible nasal endoscopy
List some important red flags for foreign bodies
Signs of airway compromise - drooling, dysphonia, stridor
Oesophageal perforation signs - chest pain, sepsis, surgical emphysema
History of battery ingestion
What is the top differential for foreign body ingestion?
Food bolus
What may foreign bodies in the ear be mistaken for?
Otitis externa
What investigations may be required for FB?
None for nose and ear
Plain film radiograph lateral soft-tissue neck
CXR
What might show on a plain film radiograph in case of ingested FB?
FB Surgical emphysema Widening of retropharyngeal tissue Loss of cervical lordosis Mediastinal widening
What does the urgency of FB removal depend on?
Nature and location of the FB
Any red flag signs - airway compromise
What may button battery ingestion lead to?
Erosion and irreversible caustic burns
How are ear foreign bodies removed?
Microscution with Zoelner sucker, crocodile forceps, Jobson-Horne probes and wax hooks
If can not be removed or against TM then discharge home with view to remove under GA
How are nose FB managed?
Emergency removal under GA should be performed if patient distressed or any signs of difficulty breathing
If unable to remove or unsure of FB then work up for GA and removal
How are throat FBs managed?
If visualised in oropharynx, removal via Magill forceps
Otherwise removal should be attempted by endoscopy under GA
When is endoscopy done as an emergency for a throat FB?
Any red flags
Any sharp or long >5cm FB
When is endoscopy done urgently (within 24hrs) for a throat FB?
Oesophageal obstruction
Blunt oesophageal FB
Magnets proximal to duodenum
When is endoscopy non urgent for a throat FB?
Disc or cylindrical batteries which have passed the stomach without signs of injury
Coins if asymptomatic
