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
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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
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Foreign body ingestion
The most common foreign bodies are represented by:
Foreign body ingestion
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Foods: meat boluses, large seeds, fish bones…
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Objects ✓harmless (coins, plastic balls) ✓vulnerable (sharp or blunt)
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Toxic containers: disk batteries, magnets, objects containing lead or drugs.
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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
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Triage methodology
Vital parameters collection: • • • • •
Respiratory frequency Heart rate Blood pressure Oxygen saturation Pain scale (FLACC, VAS)
Foreign body ingestion
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Triage decision: assignment of numerical code
The EMERGENCY is dictated by the presence of major complications such as perforation, aspiration, occlusion.
Foreign body ingestion
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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
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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
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Clinical cases
Foreign body ingestion
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Clinical case 1
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6 year old girl
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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
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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
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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
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Clinical case 1
Foreign body ingestion
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Clinical case 2
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4 year old boy
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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
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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
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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
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Clinical case 2
Foreign body ingestion
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