History of Present Illness:

A toddler is brought to the hospital with a transient cough after putting a small metallic bead in his mouth.

Vital Signs & Physical Exam:

Vital signs are normal.  Physical exam is also normal except for mild drooling.   He is protecting his airway and there is no stridor

Initial Diagnostic Testing:

Where is the object and what is the treatment?

  • A) Esophagus, scope by peds GI
  • B) Esophagus, scope by peds ENT
  • C) Trachea, scope by peds ENT
  • D) Trachea, remove with McGill’s

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

 

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QUIZ ANSWER: 

    • A) Esophagus, scope by peds GI – CORRECT – coronal plane suggests esophagus.  Whichever consultant agrees is fine
    • B) Esophagus, scope by peds ENT – CORRECT – whichever consultant agrees.  Whichever consultant agrees is fine
    • C) Trachea, scope by peds ENT – if was in trachea there would be stridor and severe coughing and respiratory distress, or worse.  The quarter would also be in a sagittal rather than coronal plane
    • D) Trachea, remove with McGill’s – this might be necessary if the child was in severe distress or apneic and you couldn’t delay for airway in the OR.  Would need to prep for a cric as well.

1-Minute Consult on this topic: Click HERE and scroll to page 94.

 

CASE CONCLUSION: went to Children’s hospital by CHET team for endoscopic removal with ENT.  It was a quarter.  There was also a metal bead in the stomach which passed in the stool without treatment.

PEARLS: when a parent thinks a kid swallowed or choked on any object, there are multiple scenarios that need to be ruled out

  1. A different or additional object that may be more dangerous than the suspected object
  2. A button battery mimicking a coin.  Batteries are much more dangerous and typically have a very similar but different appearance than a coid.

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