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2026-05-14T06:30:28Z
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https://wikem.org/w/index.php?title=Ingested_foreign_body&diff=37755
Ingested foreign body
2015-05-19T03:02:23Z
<p>Nicoloid: </p>
<hr />
<div>==Background==<br />
*Esophageal impaction can result in airway obstruction, stricture, or perforation<br />
**Perforation due to mechanical (ingested bones) or chemical corrosion (button battery)<br />
*Esophageal irritation (e.g. from swallowed bone) can be perceived as foreign body<br />
*Most common site for obstruction is upper 1/3 of esophagus<br />
*Once object has traversed pylorus usually passes without issue<br />
**Exceptions:<br />
***Irregular or sharp edges<br />
***Particularly wide (>2.5cm) or long (>6cm)<br />
<br />
==Clinical Presentation==<br />
===Adults===<br />
*Retrosternal pain<br />
*[[Dysphagia]]<br />
*[[Vomiting]]<br />
*[[Choking]]<br />
*Coughing/aspiration (if secretions pool proximal to the obstruction)<br />
===Children===<br />
*Refusal or inability to eat<br />
*[[Vomiting]]<br />
*Gagging and choking<br />
*[[Stridor]]<br />
*[[Neck pain|neck]] or throat pain<br />
*Drooling<br />
<br />
==Differential Diagnosis==<br />
*Tracheal/lung aspiration<br />
<br />
==Diagnosis==<br />
===Imaging===<br />
*CXR PA and lateral<br />
**Coins in esophagus present their face on AP view<br />
**Coins in trachea present their face on lateral view<br />
**Bones can be visualized <50% of time<br />
**"Double-ring sign = button battery (needs emergent removal)<br />
*CT chest<br />
**Very high-yield for both radiopaque and nonradiopaque objects<br />
*Endoscopy<br />
<br />
==Treatment==<br />
===Urgent Endscopy===<br />
#Complete obstruction of esophagus (pooling, risk of aspiration)<br />
#Ingestion of sharp or elongated objects (toothpicks, soda can tabs)<br />
#Ingestion of multiple foreign bodies<br />
#Ingestion of button batteries<br />
#Evidence of perforation<br />
#Coin at the level of the cricopharyngeus muscle in a child<br />
#Airway compromise<br />
#Presence of foreign body for >24hr<br />
===Food Impaction===<br />
#Uncomplicated food impaction (no bones, incomplete obstruction) manage expectantly<br />
##Do not allow food bolus to remain impacted for >12-24hr<br />
##Options<br />
###Glucagon 1-2mg IV/IM (adults)<br />
###Coca-Cola<br />
##Obtain esophagogram after treatment to ensure passage<br />
<br />
===Coin Ingestion===<br />
#Can attempt removal with a foley catheter under fluoroscopy<br />
===Button Battery===<br />
*Call the National Button Battery Ingestion Hotline: 202-325-3333 (24/7)<br />
*True emergency if located in esophagus<br />
**Perforation can occur within 6hr of ingestion<br />
**Obtain urgent endoscopic removal<br />
***If endoscopy unavailable AND <2hr since ingestion Foley balloon technique can be tried<br />
*Batteries past the esophagus can be managed expectantly w/ 24hr f/u<br />
<br />
===Sharp Objects===<br />
*Intestinal perforation from objects distal to stomach is common (up to 35%)<br />
*Require immediate removal (even if located in stomach or duodenum)<br />
**If object is distal to duodenum and pt is asymptomatic document passage w/ daily films<br />
**If object is distal to duodenum and pt symptomatic obtain immediate surgery consult<br />
===Narcotics Ingestion===<br />
*Consider whole-bowel irrigation<br />
*Endoscopy contraindicated<br />
<br />
==See Also==<br />
*[[Esophageal Foreign Body Removal with Foley Catheter]]<br />
*[[Foreign body]]<br />
<br />
==Source==<br />
Tintinalli<br />
<br />
[[Category:GI]]<br />
[[Category:Peds]]</div>
Nicoloid
https://wikem.org/w/index.php?title=Endophthalmitis&diff=37754
Endophthalmitis
2015-05-19T02:46:08Z
<p>Nicoloid: added tetanus</p>
<hr />
<div>[[File:Endophthalmitis_from_retained_foreign_body_2015-02-03_08-16.jpg|thumbnail|Endophthalmitis from retained foreign body]]<br />
<br />
==Background==<br />
*Inflammation (usually infectious) of the deep eye structures (aqueous and vitreus chambers)<br />
**Staphylococcus, Streptococcus, Bacillus cereus<br />
*Frequently leads to loss of vision (ocular emergency)<br />
<br />
==Causes==<br />
*Cataract surgery<br />
**Usually within 6 weeks<br />
*[[Globe Rupture]]<br />
**Penetrating eye trauma more at risk than blunt eye trauma<br />
*Foreign body<br />
*Extension of keratitis<br />
*Hematogenous spread/endogenous (rare)<br />
<br />
==Clinical Features==<br />
#Headache<br />
#Eye pain<br />
#Photophobia<br />
#Vision loss<br />
#Ocular discharge<br />
#May also see:<br />
##Conjunctival/scleral injection<br />
##Chemosis<br />
##Hypopyon<br />
##Uveitis<br />
<br />
==Work-Up==<br />
*Visual Acuity<br />
*Inspect of lid, cornea, sclera<br />
*Slit lamp exam<br />
*Intraocular pressure<br />
**After exclusion of [[Globe Rupture]]<br />
*Bloodwork (CBC, ESR, ) only if considering endogenous endophthalmitis<br />
*Ultrasound to look for alternative diagnosis<br />
**After exclusion of [[Globe Rupture]]<br />
<br />
==DDx==<br />
*Sterile postoperative inflammation<br />
*[[Red Eye (Unilateral)]]<br />
*[[Corneal Abrasion and Foreign Body]]<br />
*[[Uveitis]]<br />
*[[Vitreous Hemorrhage]]<br />
<br />
==Treatment==<br />
*Emergent ophtho consult (for gram stain/culture and definitive treatment of intravitreal abx)<br />
*Systemic antibiotics for endogenous endophthalmitis (rare cause)<br />
**Systemic antibiotics for other etiologies is controversial<br />
**Antibiotic prophylaxis in [[Globe Rupture]] reduces incidence of endophthalmitis to <1%<br />
**tetanus, if indicated<br />
<br />
==Disposition==<br />
*Admit<br />
<br />
==See Also==<br />
[[Eye Algorithm (Main)]]<br />
[[Globe Rupture]]<br />
<br />
==Source==<br />
Tintinalli<br />
Rosen's<br />
UpToDate<br />
<br />
[[Category:Ophtho]]</div>
Nicoloid
https://wikem.org/w/index.php?title=Parkland_formula&diff=37753
Parkland formula
2015-05-18T23:37:45Z
<p>Nicoloid: corrected formula</p>
<hr />
<div>Fluids in first 24 hrs = TBSA burned(%) x Wt(kg) x 4ml/kg + maintenance fluids<br />
<br />
Give 1/2 in first 8 hours, then give other 1/2 over next 16 hrs<br />
<br />
==See Also==<br />
*[[Burns]]<br />
<br />
[[Category:Trauma]]</div>
Nicoloid