CJEM Articles: foreign body

Displaying 1-6 of 6 results

  • A sticky situation: management of spray polyurethane foam insulation in body orifices
    November 2011 13 6
    Chris Vinden, Leigh J. Sowerby, Robert J. Sowerby

    Spray polyurethane foam insulation is commonly used in the construction industry to fill gaps, seal, and insulate. We present three cases of intentional spray foam insertion in body orifices and discuss the management of such situations in the emergency department. This series includes a case of oral foam insertion used in a suicide attempt by suffocation and two cases of rectal insertion. All of these cases had potential long-term consequences; one was life-threatening. To our knowledge, this is the first published report on the medical management and removal of foam insulation from body orifices. In all three cases, the foam insulation material was successfully removed after allowing the material to harden.

  • Corneal Limbal Foreign Bodies
    July 2011 13 4
    Abdul-Jabbar Ghauri, Imran J. Khan
  • Esophageal coin removal by emergency physicians: a continuous quality improvement project incorporating rapid sequence intubation
    January 2011 13 1
    Lance Brown, Rishi Bhargava

    Objective: The objective of this study was to describe our experience removing esophageal coins from children in a tertiary care pediatric emergency department over a 4-year period.
    Methods: We retrospectively reviewed a continuous quality improvement data set spanning October 1, 2004, through September 30, 2008.
    Results: In 96 of 101 cases (95%), emergency physicians successfully retrieved the coin. The median age of the children was 19 months (interquartile range [IQR] 13–43 months; range 4 months–12.8 years). The median time to removal of coin from initiation of intubation was 8 minutes (IQR 4–14 minutes; range 1–60 minutes). Coins were extracted using forceps only in 56 cases, whereas forceps and a Foley catheter were used in the remainder. Succinylcholine and etomidate were used in almost all cases for rapid sequence intubation prior to coin removal. Complications were identified in 46 cases: minor bleeding (13), lip laceration (7), multiple attempts (5), hypoxia (3), accidental extubation (3), dental injuries (3), bradycardia (2), coin advanced (1), right main-stem bronchus intubation (1), and other (8).
    Conclusions: Emergency physicians successfully removed esophageal coins following rapid sequence intubation in most cases. Our approach may be considered for the management of pediatric esophageal coins, particularly in an academic pediatric emergency department.

  • Penetrating craniofacial trauma from a vice clamp: case report and discussion
    January 2011 13 1
    Colleen Kjelland, Warren Thirsk

    Penetrating craniofacial trauma, although uncommon, has a high potential for death or serious morbidity from injury to vital neurovascular structures. An in situ facial foreign body, particularly if large, presents significant challenges beyond safe and timely removal. Airway management, stabilization of the object, management of increased intracranial pressure, and identification of injuries to local structures are all issues that may require addressing. We present a case of penetrating facial trauma from a vice clamp, with an in situ foreign body, that illustrates several of these challenges and provides a forum for their discussion.

  • A teaspoon in the stomach: How do we proceed from here?
    September 2010 12 5
    Danny Eytan, Itai Shavit, Ron Shaoul
  • The removal of coins from the upper esophageal tract of children by emergency physicians: a pilot study
    November 2004 6 6
    Ameer P. Mody, Aqeel Khan, Besh B. Barcega, Edward J. Vargas, James A. Moynihan, Lance Brown, Robin T. Clark, T. Kent Denmark, Tommy Y. Kim

    Objective: There are few reports in the medical literature describing removal of a coin from the upper esophageal tract of a child by an emergency physician. However, given the nature of their training and practice, emergency physicians are well suited to perform this common procedure. We describe our experience with this procedure.

    Methods: This was a retrospective review of a continuous quality improvement data set from a university-based tertiary care pediatric emergency department between Nov. 1, 2003, and Mar. 31, 2004.

    Results: Thirteen children, with a median age of 20 months, underwent rapid sequence intubation and had coins successfully removed from their upper esophageal tract by emergency physicians. In 10 cases, the coin was visible at laryngoscopy and removed with Magill forceps. In 3 cases this approach failed and a Foley catheter was used to remove the coin. One child suffered a tonsillar abrasion and two sustained minor lip trauma, but all were extubated and discharged home from the emergency department with no significant complications. Eleven of the 13 patients were successfully followed up, and the parents reported no problems.

    Conclusions: This pilot study suggests that the removal of a coin from the upper esophageal tract by an emergency physician can be both safe and effective. A larger study is needed before this procedure can be generally recommended.