Child abuse and mistreatment

Foreign body ingestion

Foreign body ingestion

DEFINITION Foreign body ingestion is the passage of an unwanted object in the digestive tract (esophagus, stomach, intestine)

Foreign body ingestion

2

Foreign body ingestion

In some cases, the type or location of the ingested foreign body creates clinical pictures of certain or potential seriousness, such as to involve the need for prompt removal of the foreign body itself.

Foreign body ingestion

3

Foreign body ingestion

The most common foreign bodies are represented by:

Foreign body ingestion

•

Foods: meat boluses, large seeds, fish bones…

•

Objects ✓harmless (coins, plastic balls) ✓vulnerable (sharp or blunt)

•

Toxic containers: disk batteries, magnets, objects containing lead or drugs.

4

Triage methodology

Assessment on the door: • Associated symptoms (cough, dyspnoea, pain, drooling, vomiting, dysphagia, hematemesis, restlessness, odynophagia, hemoptysis, enterorrhagia).

• Overall appearance of the patient.

• A.V.P.U. Data collection: It is appropriate to have information about: • nature and size of the foreign body • time and circumstances of the ingestion • last meal time • underlying pathologies

Foreign body ingestion

5

Triage methodology

Vital parameters collection: • • • • •

Respiratory frequency Heart rate Blood pressure Oxygen saturation Pain scale (FLACC, VAS)

Foreign body ingestion

6

Triage decision: assignment of numerical code

The EMERGENCY is dictated by the presence of major complications such as perforation, aspiration, occlusion.

Foreign body ingestion

7

PEDIATRIC TRIAGE OF FOREIGN BODY INGESTION TRIAGE CODE

1

2

3

4

5 from code 5

Vital parameters

from code 1

from code 2

from code 3

from code 4

Nature of the foreign body

Toxic containers: disk batteries, magnets…

Vulnerable foreign body

Harmless foreign body

Harmless foreign body Not expected with blunt shape and size < 2 cm: usually not a problem with progression

Signs and symptoms

Cyanosis, dyspnoea, drooling, digestive hemorrhage, uncontrollable bloody vomiting

Stridor, hoarseness, dysphagia, retching, “sternal encumbrance”, subcutaneous emphysema of the neck (crackles and/or hyperemia of the neck region).

Difficulty swallowing (refusal to feed), regurgitation.

Associated symptoms absent.

Score assessment

AVPU: P/U

AVPU: A/V FLACC/VAS: 8-10

AVPU: A FLACC/VAS: 4-7

AVPU: A FLACC/VAS: 3-1

TRIAGE PROCEDURES Consultancy activation

Pain therapy Revaluation

Foreign body ingestion

1

2

3

4

5

Exceeded the 60 minute wait. According to local protocol.

According to local protocol Direct or videomediated observation with constant monitoring of clinical conditions.

Repetition of part or all of the evaluation phases on the decision of the triagist, at the request of the patient, once the maximum recommended waiting time has elapsed.

8

8

Clinical cases

Foreign body ingestion

9

Clinical case 1

•

6 year old girl

•

Past pathological history: no previous hospitalizations, no medications, denies allergies Proximate pathological history: reported ingestion of disk battery 45 minutes ago approx.

Physical examination: fair general conditions, significant drooling Vital parameters: P.A. 98/65, Spo2 96% in ambient air, FR 26, FC 118, VAS 2

• • •

Foreign body ingestion

10

Clinical case 1 PEDIATRIC TRIAGE OF FOREIGN BODY INGESTION TRIAGE CODE

1

2

3

4

5 from code 5

Vital parameters

from code 1

from code 2

from code 3

from code 4

Nature of the foreign body

Toxic containers: disk batteries, magnets…

Vulnerable foreign body

Harmless foreign body

Harmless foreign body Not expected with blunt shape and size < 2 cm: usually not a problem with progression

Signs and symptoms

Cyanosis, dyspnoea, drooling, digestive hemorrhage, uncontrollable bloody vomiting

Stridor, hoarseness, dysphagia, retching, “sternal encumbrance”, subcutaneous emphysema of the neck (crackles and/or hyperemia of the neck region).

Difficulty swallowing (refusal to feed), regurgitation.

Associated symptoms absent.

Score assessment

AVPU: P/U

AVPU: A/V FLACC/VAS: 8-10

AVPU: A FLACC/VAS: 4-7

AVPU: A FLACC/VAS: 3-1

TRIAGE PROCEDURES Consultancy activation

Pain therapy Revaluation

Foreign body ingestion

1

2

3

4

5

Exceeded the 60 minute wait. According to local protocol.

According to local protocol Direct or videomediated observation with constant monitoring of clinical conditions.

Repetition of part or all of the evaluation phases on the decision of the triagist, at the request of the patient, once the maximum recommended waiting time has elapsed.

11

11

Clinical case 1

Attribution code Given the presence of a foreign body toxic to the organism, presence of drooling, a code 1 should be assigned

Foreign body ingestion

12

Clinical case 1

Foreign body ingestion

13

13

Clinical case 2

•

4 year old boy

•

Past pathological history: no pathology worthy of note, a previous hospitalization for asthmatic bronchitis (patient on Broncovaleas and Bentelan therapy). Denies drug allergies Proximate pathological history: comes with 118, ingestion of foreign body (key). Widespread abdominal pain reported Physical examination: fair general conditions Vital parameters: P.A. 95/61, FC 122, FR 23, SpO2 99% in ambient air, VAS 9

• • •

Foreign body ingestion

14

Clinical case 2 PEDIATRIC TRIAGE OF FOREIGN BODY INGESTION TRIAGE CODE

1

2

3

4

5 from code 5

Vital parameters

from code 1

from code 2

from code 3

from code 4

Nature of the foreign body

Toxic containers: disk batteries, magnets…

Vulnerable foreign body

Harmless foreign body

Harmless foreign body Not expected with blunt shape and size < 2 cm: usually not a problem with progression

Signs and symptoms

Cyanosis, dyspnoea, drooling, digestive hemorrhage, uncontrollable bloody vomiting

Stridor, hoarseness, dysphagia, retching, “sternal encumbrance”, subcutaneous emphysema of the neck (crackles and/or hyperemia of the neck region).

Difficulty swallowing (refusal to feed), regurgitation.

Associated symptoms absent.

Score assessment

AVPU: P/U

AVPU: A/V FLACC/VAS: 8-10

AVPU: A FLACC/VAS: 4-7

AVPU: A FLACC/VAS: 3-1

TRIAGE PROCEDURES Consultancy activation

Pain therapy Revaluation

Foreign body ingestion

1

2

3

4

5

Exceeded the 60 minute wait. According to local protocol.

According to local protocol Direct or videomediated observation with constant monitoring of clinical conditions.

Repetition of part or all of the evaluation phases on the decision of the triagist, at the request of the patient, once the maximum recommended waiting time has elapsed.

15

15

Clinical case 2

Attribution code Given the presence of a vulnerating foreign body, intense pain the VAS equal to 9, a code 2 is assigned

Foreign body ingestion

16

Clinical case 2

Foreign body ingestion

17

17