A swallowed watch (button) battery can cause fatal perforation with mediastinitis if lodged in the oesophagus. The need to removed urgently under general anaesthesia makes this a ‘timely’ emergency.
- If there is an insect in the external auditory canal, kill it first. They will fight for their lives if you try to dismember or take them out. “In the heat of battle, the patient can become terrorized by the noise and pain and the instrument that you are using is likely to damage the ear canal.”
- Vegetable matter in the ear? Don’t irrigate it – the organic material will swell against the fixed structure, and cause more pain, make it much harder to extract, and may increase the risk of infection.
- Beware of unilateral nasal discharge in a child – strongly consider retained foreign body
- Children 1 year and up, conscious – Heimlich maneuver: stand behind patient with arms positioned under the patient’s axilla and encircling the chest. The thumb side of one fist should be placed on the abdomen below the xiphoid process. The other hand should be placed over the fist, and 5 upward-inward thrusts should be performed. This maneuver should be repeated if the airway remains obstructed.
- More than 100,000 foreign body ingestions are reported in children each year; coins are #1 cause
- Although not always 100% true, coins typically appear circular on an AP Xray of the neck when in the esophagus and linear when in the trachea
- Coins usually pass without issue, but warning signs are drooling, dysphagia, hoarse voice, wheezing, or stridor
- 10-20% require endoscopy for removal and 1% require surgery
- Objects lodged in the middle esophagus should raise concern for underlying pathology such as strictures, masses, or webs