Foreign Bodies ============== þ Non-radio-opaque FB (e.g., bottle cap) - ? if refusing oral intake - ? admit, send out for followup today or tomorrow with pediatrician, or ask ENT or GI to see in ED. Low-risk object, no symptoms > observation; symptoms > endoscopy High-risk object, no symptoms > observation; minimal symptoms > barium study 8-16 hours observation standard for kids with esophageal coin FB if takes liquids but refuses solids, lower esophageal coin FB, radiolucent halo or moth-eaten edge on xray is pathognomonic for button battery. Using a Foley to remove esophageal FBs: only for round FBs less than 24 hours. Inferior to endoscopy. Using a bougie to force into stomach: too many complications. Rigid endoscopy by ENT in kids is best. Can use sumatriptan: relaxes lower esophageal sphincter. No studies. Spontaneous passage more likely the lower in the esophagus the FB is. If in stomach: may take weeks. Don't need to examine stool. Followup if pain or vomiting. Remove only if needle, FB > 5cm in > 1 year old, >3 cm if < 1 year old. Magnets: multiple magnets may pull bowel loops together and cause pressure necrosis. Possible aspirated FB: - remember in case ever has a pneumonia - check inspiratory and expiratory CXR - can send home for followup with PCP if negative - if high suspicion, or abnormal CXR, bronchoscopy (flexible to locate, rigid to remove) þ Nasal Foreign Bodies - have mom hold one nostril closed and blow in the kid's mouth. [Kadish HA. Removal of nasal foreign bodies in the pediatric population. American Journal of Emergency Medicine. 1997;15:54-56.] [Backlin SA. Positive-pressure technique for nasal foreigh body removal in children. Ann Emerg Med 199?;25:554.] þ aspiration of foreign bodies - about similar frequency of right and left mainstem bronchus FB - get inspiratory and expiratory films; if unable, try decubitus films; if acting as check-valve, even with affected side down, affected side will still be hyperinflated. þ GI Foreign Bodies