Rosen & Barkin's 5-Minute Emergency Medicine Consult
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Davidson BASICS DESCRIPTION Esophageal foreign bodies (FBs) typically lodge at 3 sites of physiologic constriction: Cricopharyngeal muscle—63%, most common (C6) Gastroesophageal junction—20% (T11) Aortic arch—10% (T4) 90% of ingested FBs pass spontaneously.
10–20% are removed endoscopically, and 1% or less require surgery.
ETIOLOGY Most common adult and adolescent FBs are food boluses and bones Increased risk: Edentulous adults Intoxicated patients Patients with underlying esophageal disease: Sc...hatzki B-rings or peptic strictures are most common Pediatric Considerations 80% of FB ingestions occur in pediatric age group, peak ages 6 mo–6 yr, particularly younger than 2 yr.
Coins are most common: Most common: 80% of esophageal FBs 2 additional areas of constriction: Thoracic inlet (T1) and tracheal bifurcation (T6) DIAGNOSIS SIGNS AND SYMPTOMS Acute ingestion: Dysphagia Odynophagia Drooling Retching/self-induced vomiting Choking Gagging Blood-stained saliva Chronically retained FB: Respiratory symptoms predominate (paraesophageal tissue swelling compromises adjacent trachea): Cough Stridor Hoarseness Chest pain Site of FB sensation usually corresponds to esophageal level of FB Esophageal perforation 15–35% if ingest sharp object: Redness Swelling Crepitus in the neck Peritonitis <20% asymptomatic Pediatric Considerations Signs/symptoms: Refusal to eat Stridor Upper respiratory tract infection Neck/throat pain History Adults: Usually provide unequivocal history 80% present within 1st 24 hr 5% will present with airway obstruction (cafe coronary) Children: 50% asymptomatic History can be unclear if unwitnessed ingestion is not witnessed Drooling, refusal to eat, unexplained gagging, cough, wheeze, choking More likely than adults to have respiratory symptoms ESSENTIAL WORKUP History about object ingested: Type, when, and how Physical exam focused by degree of distress exhibited: Esophagus: Obstruction—saliva pooling, aspiration Perforation—crepitus, pain, pleurisy Hemorrhage Oropharynx: Red, irritated throat Palatal abrasions Lung: Stridor and wheezing Abdomen: Peritonitis or bowel obstruction DIAGNOSIS TESTS & NTERPRETATION Imaging Biplane chest radiograph including all of neck for FB localization: Food boluses usually do not need radiographs.
What to read after Rosen & Barkin's 5-Minute Emergency Medicine Consult?
You can find similar books in the "Read Also" column, or choose other free books by Peter Rosen to read onlineMoreLess
To quickly assess the difficulty of the text, read a short excerpt:
Davidson BASICS DESCRIPTION Esophageal foreign bodies (FBs) typically lodge at 3 sites of physiologic constriction: Cricopharyngeal muscle—63%, most common (C6) Gastroesophageal junction—20% (T11) Aortic arch—10% (T4) 90% of ingested FBs pass spontaneously.
10–20% are removed endoscopically, and 1% or less require surgery.
ETIOLOGY Most common adult and adolescent FBs are food boluses and bones Increased risk: Edentulous adults Intoxicated patients Patients with underlying esophageal disease: Sc...hatzki B-rings or peptic strictures are most common Pediatric Considerations 80% of FB ingestions occur in pediatric age group, peak ages 6 mo–6 yr, particularly younger than 2 yr.
Coins are most common: Most common: 80% of esophageal FBs 2 additional areas of constriction: Thoracic inlet (T1) and tracheal bifurcation (T6) DIAGNOSIS SIGNS AND SYMPTOMS Acute ingestion: Dysphagia Odynophagia Drooling Retching/self-induced vomiting Choking Gagging Blood-stained saliva Chronically retained FB: Respiratory symptoms predominate (paraesophageal tissue swelling compromises adjacent trachea): Cough Stridor Hoarseness Chest pain Site of FB sensation usually corresponds to esophageal level of FB Esophageal perforation 15–35% if ingest sharp object: Redness Swelling Crepitus in the neck Peritonitis <20% asymptomatic Pediatric Considerations Signs/symptoms: Refusal to eat Stridor Upper respiratory tract infection Neck/throat pain History Adults: Usually provide unequivocal history 80% present within 1st 24 hr 5% will present with airway obstruction (cafe coronary) Children: 50% asymptomatic History can be unclear if unwitnessed ingestion is not witnessed Drooling, refusal to eat, unexplained gagging, cough, wheeze, choking More likely than adults to have respiratory symptoms ESSENTIAL WORKUP History about object ingested: Type, when, and how Physical exam focused by degree of distress exhibited: Esophagus: Obstruction—saliva pooling, aspiration Perforation—crepitus, pain, pleurisy Hemorrhage Oropharynx: Red, irritated throat Palatal abrasions Lung: Stridor and wheezing Abdomen: Peritonitis or bowel obstruction DIAGNOSIS TESTS & NTERPRETATION Imaging Biplane chest radiograph including all of neck for FB localization: Food boluses usually do not need radiographs.
What to read after Rosen & Barkin's 5-Minute Emergency Medicine Consult?
You can find similar books in the "Read Also" column, or choose other free books by Peter Rosen to read onlineMoreLess
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