Nasal foreign bodies are surprisingly common. The technique is not too dissimilar to that of removing auricular foreign bodies. In theory, they might be hidden behind a turbinate and tricky to see - and therefore tricky to remove.
1. Mother's Kiss
This works in 60% of cases. Occlude patent nostril. Get Mum to blow into the mouth. You can do this with a BVM if needed - but be careful the pressure isn't too high.
2. Suction
Like with FBs in the ear, gentle suction, can help. I guess glue could too - although I haven't seen any case reports of this.
3. Curved Needles
If you can't find one, as we can never find them in the ED, bend a green needle, and that should help!
4. Foley Catheter
Inflate baloon with 0.5 - 3ml water or air. Insert it behind the foreign body, and then pull. I've never tried this, but it seems to be really frequently used outside the UK!
References
http://journals.lww.com/em-news/blog/M2E/Pages/post.aspx?PostID=17
http://www.emdocs.net/ear-nose-throat-foreign-bodies/
https://wikem.org/wiki/Nasal_foreign_body
http://pmj.bmj.com/content/76/898/484
http://epmonthly.com/article/how-to-remove-a-nasal-foreign-body-with-a-balloon-catheter/
https://lifeinthefastlane.com/nasal-foreign-bodies/
http://www.racgp.org.au/download/Documents/AFP/2013/May/201305handi.pdf
http://emedicine.medscape.com/article/763767-overview?pa=kFsFTvrB8j%2FPtwK%2BOEAs61ub09VNBtvaAN6mPVwMp%2FDFndF9mwj4ym0rESwqOfDUa5AxknqcRm1Zi18mAza%2B0XnZ5j5IICuJuaa3Z%2BY2XGY%3D#a4
Showing posts with label foreign body. Show all posts
Showing posts with label foreign body. Show all posts
Thursday, 6 July 2017
Wednesday, 3 June 2015
Foreign Bodies
Children often swallow things. The management pretty much depends on what they have swallowed, and whether they have symptoms or not. If the child is coughing, consider that they may have inhaled the foreign body instead - the inhaled FB can act as a ball-valve and air can enter but not leave.
The Object
Button batteries, objects >5mm and sharp, and razor blades are considered dangerous. Button batteries are toxic, and have a slow but deep action, and can also cause direct pressure necrosis. Their effects may be seen after they have been removed. Open safety pins might be dangerous - sharp objects have a 15 - 35% risk of perforation.
Imaging
1. X-ray if likely to be radio-opaque or "dangerous". Request a neck and chest x-ray- an abdomen is not needed, and irradiates the gonads un-necessarily.
Look at the x-ray carefully- common points that get stuck are:
- C6 is cricopharyngeal sling and upper oesophageal sphincter
- 15% get stuck in the midoesophagus where the aortic arch and carina push on the oesophagus.
- 15% get stuck in the lower oesophageal sphincter / oesophagogastric junction
Check carefully it is a coin and not a button battery. If you are not sure if the coin is in the oesophagus or not, do a lateral film. If the coin is in the oesophagus, it appears coronal. Tracheal objects appear in a sagittal orientation.
2. Dangerous Object - refer to surgeons where ever the object is. There is some debate about button batteries if they are below the diaphragm. Above the diaphragm - in the oesophagus, nose or throat, they need to come out ASAP.
3. Above diaphragm, symptomatic, - refer to the surgeons. Most (75%) objects impact in the upper oesophagus.
b. Mild or no symptoms - home, repeat x-ray 24 hours.
4. Below diaphragm
Reassure, return if symptoms develop
5. Asymptomatic, not seen - reassure and return if symptoms develop.
b. Symptomatic - refer to surgeons
There is no need to search the poo. It might take six weeks for the foreign body to come out.
Metal Detector
The metal detector can help prove whether a FB is above the diaphragm or not. They can confirm whether the coin has reached the stomach.
The Object
Button batteries, objects >5mm and sharp, and razor blades are considered dangerous. Button batteries are toxic, and have a slow but deep action, and can also cause direct pressure necrosis. Their effects may be seen after they have been removed. Open safety pins might be dangerous - sharp objects have a 15 - 35% risk of perforation.
Imaging
1. X-ray if likely to be radio-opaque or "dangerous". Request a neck and chest x-ray- an abdomen is not needed, and irradiates the gonads un-necessarily.
Look at the x-ray carefully- common points that get stuck are:
- C6 is cricopharyngeal sling and upper oesophageal sphincter
- 15% get stuck in the midoesophagus where the aortic arch and carina push on the oesophagus.
- 15% get stuck in the lower oesophageal sphincter / oesophagogastric junction
Check carefully it is a coin and not a button battery. If you are not sure if the coin is in the oesophagus or not, do a lateral film. If the coin is in the oesophagus, it appears coronal. Tracheal objects appear in a sagittal orientation.
2. Dangerous Object - refer to surgeons where ever the object is. There is some debate about button batteries if they are below the diaphragm. Above the diaphragm - in the oesophagus, nose or throat, they need to come out ASAP.
3. Above diaphragm, symptomatic, - refer to the surgeons. Most (75%) objects impact in the upper oesophagus.
b. Mild or no symptoms - home, repeat x-ray 24 hours.
4. Below diaphragm
Reassure, return if symptoms develop
5. Asymptomatic, not seen - reassure and return if symptoms develop.
b. Symptomatic - refer to surgeons
There is no need to search the poo. It might take six weeks for the foreign body to come out.
Metal Detector
The metal detector can help prove whether a FB is above the diaphragm or not. They can confirm whether the coin has reached the stomach.
(flowchart from the amazing and well worth buying http://www.amazon.co.uk/Emergency-Care-Minor-Trauma-Children/dp/144412014X
References
http://dontforgetthebubbles.com/the-magic-coin/
http://dontforgetthebubbles.com/podcast-week-button-batteries/
http://lifeinthefastlane.com/ccc/inhaled-foreign-body/
http://lifeinthefastlane.com/top-ten-foreign-bodies/
http://wikem.org/wiki/Esophageal_foreign_body
http://www.annemergmed.com/article/S0196-0644(84)80573-9/abstract
http://lifeinthefastlane.com/paediatric-quiz-017/
http://emedicine.medscape.com/article/801821-treatment
http://www.ncbi.nlm.nih.gov/pubmed/15913481
http://learnpediatrics.com/body-systems/gastrointestinal/suspected-foreign-body-ingestion/
http://www.sciencedirect.com/science/article/pii/S0165587612006519
http://blog.clinicalmonster.com/2015/03/foreign-body-ingestions-in-children-by-abi-iyanone/
http://pediatriceducation.org/2005/03/28/
http://www.sinaiem.org/pearls/2015/05/26/fool-me-once/
http://www.amazon.co.uk/Emergency-Care-Minor-Trauma-Children/dp/144412014X
http://www.amazon.co.uk/books/dp/0199589569
http://dontforgetthebubbles.com/podcast-week-button-batteries/
http://lifeinthefastlane.com/ccc/inhaled-foreign-body/
http://lifeinthefastlane.com/top-ten-foreign-bodies/
http://wikem.org/wiki/Esophageal_foreign_body
http://www.annemergmed.com/article/S0196-0644(84)80573-9/abstract
http://lifeinthefastlane.com/paediatric-quiz-017/
http://emedicine.medscape.com/article/801821-treatment
http://www.ncbi.nlm.nih.gov/pubmed/15913481
http://learnpediatrics.com/body-systems/gastrointestinal/suspected-foreign-body-ingestion/
http://www.sciencedirect.com/science/article/pii/S0165587612006519
http://blog.clinicalmonster.com/2015/03/foreign-body-ingestions-in-children-by-abi-iyanone/
http://pediatriceducation.org/2005/03/28/
http://www.sinaiem.org/pearls/2015/05/26/fool-me-once/
http://www.amazon.co.uk/Emergency-Care-Minor-Trauma-Children/dp/144412014X
http://www.amazon.co.uk/books/dp/0199589569
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