UNFINISHED CASE – A WORK IN PROGRESS
History of Present Illness:
A toddler is brought to the hospital with drooling and throat pain after chocking on a quarter. The father tried to pull it out but was unsuccessful.
Vital Signs & Physical Exam:
Vital signs are normal. Physical exam is also normal except for mild drooling and obvious discomfort. He is protecting his airway and there is no stridor
Initial Diagnostic Testing:
- Imaging:
Where is the quarter and what is the treatment?
- A) Esophagus, scope by peds GI
- B) Esophagus, scope by peds ENT
- C) Trachea, scope by ENT
- D) Trachea, remove with McGill’s
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
<<<<<<<<<<<<<<<<<<<<< ADVERTISEMENT & SPACER >>>>>>>>>>>>>>>>>>>>>
THE EMERGENCY MEDICINE POCKETBOOK TRIFECTA
Emergency Medicine 1-Minute Consult, 5th edition
A-to-Z EM Pharmacopoeia & Antibiotic Guide, NEW 5th edition (currently printable pdf only)
8-in-1 Emergency Department Quick Reference, 5th edition
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<<<<<<<<<<<<<<<<<<<<<<<<< END SPACER >>>>>>>>>>>>>>>>>>>>>>>>>
QUIZ ANSWER: Where is the quarter and what is the treatment?
-
- 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 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
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