1. Foreign Bodies and Their Removal Part 1 -
“you’ve got to know when to hold ‘em, know when to fold ‘em, know when to walk away and know when to run…” - Kenny Rogers
Dr. Arleigh Trainor, MD FACEP FAAEM
Chief Division of Emergency Medicine
USD SSOM
Education Coordination Emergency Department
Sanford USD Medical Center

2. Objectives Review some common foreign bodies. Review:
which foreign bodies in what locations should be removed by Emergency Medicine Physicians
which should be removed by specialists
which should not be removed unless they begin to cause issues.
Review common foreign body removal techniques.

3. Disclosures - none
Employee of Sanford USD Medical Center and Sanford School of Medicine - University of South Dakota

4. The Eyes Have It …. Be the reporter History Exam
Equipment : Snellen chart, topical anesthetic, cotton swab, needle ( blunt or 18 g, fluorescein stain ( strip or drops), opthalmoscope. Optional ( spud, burr drill, Wood’s lamp, slit lamp). Schiotz or tonopen.
Visual acuity
Look at the eye, evert the lid, do a fundoscopic exam, stain it, look at it with a blue light ( this is on your opthalmoscope) or with a Woods lamp or with a slit lamp.

5. Trick to dispense drops
Both adults and children
drip onto medial canthus

6. Make your own fluorescein eye drop

7. Why everyone freaks out….
Is it in the eye or just imbedded in the surface?
Seidel’s sign
3A1dePc

8. Now what? https://vimeo.com/62213688
In the globe with rupture - imaging ( orbit CT)
Corneal FB
What is it? Does it need to come out now or later?
organic, should come out if possible, consult and refer ( up to specialist if need immediate or next day)
inorganic, come out but if not causing further damage consult and refer ( up to specialist)
rust rings
A. Corneal rust ring; B. Use of moist cotton tip; C. Further removal with 25G hypodermic needle; D. 15 blade scalpel

9. Ears, tears and fears…or if it’s bigger than your elbow don’t put it in your ear!
History
Exam - Let there be light! Be calm and carry on ( do they need a little something?)
Numb it up!
Irrigate/suction/pick/glue/magnet?
Refer ( now or later?) - if perforation typically need to refer.

10. How can I see in there? Old school - otoscope
Old school - otoscope
New school - pediatric glide scope, lighted curette

11. Irrigate
Only warm water! Beware of COWS, also alcohol, 2% lidocaine, mineral oil, colace.
Drown the suckers!
Contraindicated with organic material, perforated TMs, h/o ear surgery, disc batteries

12. Suck it out! Frazer suction butterfly tubing Yankauer suction Hognose

13. Pick it! Alligator forceps Tweezers Cotton swab with glue Ball hook
Magnets

15. What did you put in your nose?
History
Exam
Get it out of there!
mother’s kiss technique and modified version.
Suction ( catheter)
Pick
Glue
Foley/Katz extractor

16. Don’t put that in your mouth!
History
Exam
Imaging
Now or later?

17. Fishbone Hurricane spray DL/VL McGill forceps

18. Food impaction
Glucagon?
Nitro?
Endoscopy

20. Coins Not just history but potential for ingestion
Where is it? Imaging vs metal detector?
How far to transfer if needed?
Endoscopy,foley catheter removal, bougeinage, observation

22. https://hqmeded.com/pediatric-esophageal-coin-bougienage/

23. Batteries and magnets Guideline Consult - nuff said!