Pediatric ER Flashcards
Kids who swallow a button battery what to do? How does management change with location?
This patient should be observed with consideration of repeat imaging as the patient is asymptomatic, has normal vital signs, has a normal physical exam, and the battery is located in the jejunum, not in the stomach, esophagus, or trachea.
Critical history components include: the battery type, time of ingestion, number of batteries ingested, if any magnets were ingested, and any symptoms that have already occurred. Concerning symptoms include chest pain, cough, shortness of breath, abdominal pain, hematemesis or hematochezia, fever, and refusal of oral intake. Abnormal vital signs should raise concern for complications.
Diagnosis is made by history and by plain radiograph. Radiographs should cover the entire GI tract from mouth to anus. Management of battery ingestion starts with addressing the airway, breathing, and circulation. Maintain NPO (nothing by mouth) status initially. If radiographs reveal evidence of esophageal impaction or if the battery is located in the stomach, emergent endoscopy is warranted. If the patient is asymptomatic, they may be observed as an outpatient and do not require emergent intervention. They should be given strict return precautions (return to the emergency department with any new abdominal pain, fever, vomiting, rectal bleeding) and may require outpatient follow-up imaging. Button batteries that are in the intestines usually pass within one week. Radiographic imaging may be obtained in follow-up to confirm passage.
Initial management of laryngotracheitis?
The most important initial management of laryngotracheitis (of the options listed above) is to give nebulized epinephrine (racemic or L-epinephrine) which acts almost immediately to reduce upper airway inflammation and edema. Dexamethasone has been shown to improve croup scores and reduce the need for epinephrine, reduce hospital and emergency length of stay, and reduce follow-up requirements, but does not take effect for 6 or more hours.
