Project: Ghana Emergency Medicine Collaborative Document Title: Aspirated and Ingested Foreign Bodies Author(s): Jim Holliman (Uniformed Services University of the Health Sciences), MD 2012 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/ We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. These lectures have been modified in the process of making a publicly shareable version. The citation key on the following slide provides information about how you may share and adapt this material. Copyright holders of content included in this material should contact [email protected]with any questions, corrections, or clarification regarding the use of content. For more information about how to cite these materials visit http://open.umich.edu/privacy-and-terms-use. Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition. Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers. 1
74
Embed
GEMC: Aspirated and Ingested Foreign Bodies: Resident Training
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Project: Ghana Emergency Medicine Collaborative Document Title: Aspirated and Ingested Foreign Bodies Author(s): Jim Holliman (Uniformed Services University of the Health Sciences), MD 2012 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/
We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. These lectures have been modified in the process of making a publicly shareable version. The citation key on the following slide provides information about how you may share and adapt this material. Copyright holders of content included in this material should contact [email protected] with any questions, corrections, or clarification regarding the use of content. For more information about how to cite these materials visit http://open.umich.edu/privacy-and-terms-use. Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition. Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.
1
Attribution Key
for more information see: http://open.umich.edu/wiki/AttributionPolicy
• The person can often point to the level of the obstruction
• Dysphagia • Odynophagia
47
Coin Ingestions • Quarters are 24 mm. in diameter • Esophagus is 17 x 23 mm. in size • Before 1982 pennies were 95 % copper & 5 % zinc • Since 1982 pennies are 97.6 % zinc
• Zinc is more corrosive than copper • Coins tend to lodge in frontal (coronal) plane in
esophagus (sagittal if in trachea) • Up to 30 % of children with coins lodged in the
esophagus may be asymptomatic
48
Coin in upper esophagus Source unknown 49
Diagnosis of Esophageal Foreign Bodies
• CXR / neck films always indicated • Should get in 2 planes in case more
than one coin ingested • Consider dilute barium or gastrografin
swallow for radiolucent foreign bodies like food
• May order as "alimentary tract" film for kids
50
"Conservative" Initial Treatment for Impacted Food in the Esophagus
• Glucagon 0.5 to 2.0 mg (usually 1.0 mg) IV or IM • Success rate 20 to 50 %
• Nifedipine 10 mg SL • Nitroglycerin 0.4 mg SL • Diazepam 5 to 10 mg IV • Atropine 0.5 to 1.0 mg IV or IM
51
"Invasive" Removal of Esophageal Foreign Bodies
• Flexible fiber optic endoscopy • Usually method of choice • General anesthesia may be required in children • If food impaction, may be pushed into stomach
rather than removed • Foley catheter extraction
• Patient must be in head - down position • Only suitable for upper esophageal impactions
• Nasogastric suction or magnet (needs fluoroscopy) • Rare earth cobalt magnet useful for button batteries
52
Unsafe Methods for Esophageal Food Impaction Removal
• Meat tenderizer (papain) • Has caused esophagitis & deaths from