Foreign Bodies Complications: Fun Ways to Get Them Off or Out Incr - PDF document

4/18/2013 Foreign Bodies Complications: Fun Ways to Get Them Off or Out Incr ’ d Risk if > 24 hours You Got WHAT Stuck WHERE?? Angela C. Anderson, MD, FAAP Pediatric Emergency Medicine Brown University Medical School Hasbro Children ’ s Hospital Providence, Rhode Island Thoracic Inlet Aortic Arch GE Sphincter 1

4/18/2013 20% of patients are asymptomatic qu'est-ce-que c ’ est ? 2

4/18/2013 Mechanisms of Injury  Pressure Necrosis  Current between cathode & anode  Leakage  KOH or NaOH  liquefaction necrosis Disc Batteries Esophageal Damage from What are people doing?.. Disc Batteries  Hearing aid battery vs. medication  Time to Burn  “ Testing ”  4 hours  “ 3rd Hand ”  1989 Ghost Blaster toys  Time to Perforation  53 in 8 weeks  6 hours How Big is too Big? Which Batteries require removal?  Battery  15 mm  Esophagus:  Child < 6 years  100% immediately  Distal to Esophagus:  Patients w/ significant symptoms:  Abdominal pain with tenderness  Melena  Hematochezia 3

4/18/2013 When to repeat x-rays? When to repeat x-rays?  Battery In Stomach:  Battery past Pylorus  Larger than a dime  Repeat film every 1 - 2 weeks  Child < 6 years X-ray q 2-3 days  National Button Battery I ngestion Hotline 202-625-3333 GI Foreign Bodies Lead (non-esophageal)  Whole Bowel Irrigation  Polyethylene Glycol  Colyte or GoLYTELY  500 cc / hour (children) If it ’ s in the stomach…go get it!  1-2 liter / hour (adults) 4

4/18/2013  Clitoral and penile hair tourniquets ? Swollen Toemorrow Hair Tourniquet Removal  Douglas DD. Dissolving hair wrapped around an infant's digit. J Pediatr. 1977;91:162 5

4/18/2013 Ticks 6

4/18/2013 Rings and things 7

4/18/2013 Tar Roads 275 to 300 o F Tar / Asphalt  Tar is sterile.  Skin is not!  Occlusive barrier Bacterial proliferation. Management Tar Removal  Neosporin  Cooling  Tween 80  Tar removal ??  Poloxamer 188  Cream better than ointment 8

4/18/2013  A 15 year old girl presents with intractable coughing.  On exam:  Lungs: CTA  Heart: RRR no murmurs  HEENT: hair in the left ear canal Ears Do you care? Unusual Side Effects of Aural Foreign Bodies  Persistent cough  Hiccups First Described in 1832 The Hair and The Ant 7 yo with cough x 7 years  Annals Emergency Med Jan 1982, 11(1): 24  New England Journal of Med March 1988, 318(11):711 The Lancet Vol 360,Aug,2002 9

4/18/2013 Irrigation Hiccup Reflex Arc Meningitis Branches: Mass Auricular Vagus Alcohol Meningeal CNS Nerve Laryngeal Thoracic Abdominal Phrenic Cervical Nerve Mediastinal Diaphragmatic Water Pick??? Nope S KumarEmerg. Med. J. 2005;22;266-268 Irrigation Equipment Irrigation Equipment  20cc Syringe  20cc Syringe  14 or 16g Angiocatheter  14 or 16g  Cut the catheter ! Angiocatheter S Kumar Emerg. Med. J. 2005;22;266-268 10

4/18/2013 Pressure generated by Elephant 20cc syringe and cannulas EAR Washer  14 gauge: 8 kPa 60 mmHg System  16 gauge: 7 kPa 50 mmHg  18 gauge: 4 kPa 30 mmHg Median Pressure to rupture the TM: 60 kPa S Kumar Emerg. Med. J. 2005;22;266-268 Auricular Irrigation Cyanoacrylates to Remove Ear FB ’ s  Not if:  TM is perforated  Battery  Not for:  Hygroscopic objects  vegetables, beans, etc. Warm 3% hydrogen peroxide “ A novel approach to the removal of Superglue from the ear. ”  Persaud R - J Laryngol Otol - 01-Nov-2001; 115(11): 901-2 11

4/18/2013 Antonelli, 2001 Laryngoscope Bugs in the Ear H20 Lido + epi 1% Lido Vinegar 4% Lido Oil Isopropyl Alcohol Ethanol 'A parent's kiss': evaluating an unusual method for removing nasal foreign bodies in children.  Botma M - J Laryngol Otol - 01-Aug-2000; 114(8): 598-600 “ Kiss ” it out ! “ A Kiss ” Light Source  Neo-Synephrine (+ / - )  Mouth open widely  Occlude unaffected nostril  Parent delivers a breath with a tight seal. 12

4/18/2013 Katz Extractor Nasal Foreign Bodies Direct Removal  Neo-Synephrine + /-  Topical anesthetic + /-  Papoose + + + + + + + + + + + +  Trendelenburg 2.Depress Syringe to I nflate 1. Insert Past Foreign Body Balloon 13

4/18/2013 Magnets  Won ’ t work for:  May work for:  Iron  Gold  Nickel  Silver  Cobalt Magnets  Auricular  Nasal  Wounds 14

4/18/2013 Uh, oh…. + = ?? Superglue Magill Forceps Glue Eye Management  Mineral oil compresses overnight 15