EM Forum Case #98 "Another Fred Case"
by Charlene Babcock Irvin, MD, FACEP
My sister Cindy called me to ask a ‘medical question.’
“Fred came to me and told me he ate a penny. He looks fine. Do I need to worry?
I’m not even sure he did, but Kathleen said she saw him playing with money.”
Cindy asked.
“Ask him to point where the penny is?”
After hearing her ask Fred to point where the penny is, she replied, “He points
to his neck, just above where the neck and chest come together.”
“Any change in his voice, or was he coughing a lot? Any breathing problems or is
he drooling?”
“No, nothing at all. I bet he didn’t even swallow the penny. I’m sure its
nothing.”
“He needs to go to the ED. Take him to the hospital for an x-ray.”
“No way, I’m not even sure he really swallowed the penny…you’ve got to be
kidding”
I then explained how children usually are able to point to where the foreign
body is, and that it is likely he did swallow a penny, and now it’s stuck in the
esophagus. Foreign bodies in the esophagus are not that uncommon, especially in
preschoolers. And, how would Fred know the location of common impactions?
After a little more convincing, she did take him to the local hospital, where a
chest x-ray did reveal a retained coin shaped object at the thorasic inlet.
Questions:
1. How can you tell on chest x-ray if it’s in the esophagus or the trachea?
2. If the child is asymptomatic, do you really need to rule out coin impactions?
3. How quickly do coins in the esophagus need to be removed?
4. Does glucagon work to help foreign bodies pass into the stomach?
5. Where do foreign bodies get stuck in the esophagus?
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