Ped case conference ~ foreign body ~~2008/06/25 Presented by : R2 沈朝賢 Supervisor : VS 吳孟書

Case 1. General data 年齡: 4y 性別: male Vital sign: T/P/R: 37.3/113/22 C/C: 吞食棋子, 輕度呼吸窘迫

Present illness Miss swallowing 圍棋棋子15 min ago PAT: Appearance: easy looking Breathing: smooth, no retraction Circulation: stable PE: essentially normal

Initial order CXR (including abdomen) Abdomen (5 min later) Neck soft tissue lat. View (5 min later)

Another 5 min later… Dysphagia +, Nausea without vomiting Can’t speak well, can’t drink water/ salivation + Consult ENT => r/o F/B miss-swallowing May arrange PES if indicated

Transfer to 林口 ER Drooling, no air way compromise Consult ENT => Rigid esophagoscopy is not indicated arrange PES if symptoms persisted MBD and OPD f/u

RTC to PES OPD next day Sore throat +, drooling + => Admission Panendoscopy removed 圍棋 smoothly Patient discharged 3 days later

Case 2. General data 年齡: 1y/1m 性別: female Vital sign: T/P/R: 38.1/195/30 C/C: 吞食異物, 重度呼吸窘迫

Present illness SOB, tachypnea was noted; 由LMD轉入, 疑似異物 媽媽昨晚有給病人吃花生, 但不知是否有chocking 呼吸音哮吼,胸骨凹陷,皮膚顏色蒼白

Initial order CXR stat Admission to PICU On O2 hood

CXR

ABG PH: 7.231 PCO2: 51.6 PO2: 100.3 HCO3: 21.2 SBE: -6.4 Sat: 96.4

Flexible bronchoscope Foreign body impacted immediately in the subglottic level with partial airway obstruction Suggestion: consult ENT doctor for extraction of foreign body

OP note Anesthesia was done throughout bronchoscopy Foreign body was found at subglottic region with surrounding mucosa edematous change Foreign body (peanut) was removed into 2 pieces during operation

Hospital course Dexan was used for 2 days Extubation 3 days later Discharged 4 days later

Thanks for your attention !!