Foreign Bodies



Foreign Bodies


Amina Lalani



Introduction



  • If early attempts at foreign body removal are unsuccessful, consider referral and/or procedural sedation


Nose



  • Usually history of putting object into nose


  • Persistent, unilateral, foul-smelling, purulent rhinorrhea: nasal foreign body until proven otherwise


  • Usually visible in anterior nares; may have to suction purulent secretions


  • Radiographs not helpful; most foreign bodies are radiolucent


Techniques for Removal



  • Standard: curette, alligator forceps, suction, right-angle hook


  • Alternative methods for removal:



    • Nasal positive pressure techniques


    • Magnetic removal


    • Glue


Removal of Nasal Foreign Bodies



  • Adequately restrain child


  • Apply topical anesthetic and vasoconstrictor



    • 2% lidocaine


    • Phenylephrine or xylometazoline


  • Use nasal speculum and headlight


  • Equipment: curette, alligator forceps, suction, or hook


  • Do not push/irrigate into posterior nasopharynx in case of aspiration


  • Consider amoxicillin to prevent/treat infection after removal of long-standing FB



  • Complications: rhinosinusitis, laceration, epistaxis, aspiration, incomplete removal


Nasal Positive Pressure Techniques



  • Older child: ask child to blow nose while occluding unaffected side


  • Apply self-inflating bag-valve mask over mouth only and give positive pressure ventilation


  • Parent blows into child’s mouth: 80% success rate in one study


Magnetic Removal of Nasal Foreign Bodies



  • Magnet can be applied to nostril to remove metallic FB


  • Avoids need for anesthetic, easy and safe


Ear



  • Mostly solid objects: stones, beads, erasers


  • Live insects may also enter canal


  • Round objects can be removed with warm water irrigation



    • Not if suspected perforation, ear tube, or object has potential to swell (e.g., vegetative matter)


Methods of Removal



  • Ear curette, alligator forceps, irrigation, suction, glue


Soft Tissue



  • Earrings, lip and tongue studs


  • Grasp and remove earring stud from posterior, mucosal, or inferior aspect


  • Thread front of earring forward through soft tissue to remove


  • May require local anesthesia and small incision


Digit


Strangulating Ring



  • Three removal techniques: ring cutting, string compression, string pull



Ring Cutting

Jun 22, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Foreign Bodies

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