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Published byFrida Isaksson Modified over 5 years ago
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Ped case conference ~ foreign body ~~2008/06/25
Presented by : R2 沈朝賢 Supervisor : VS 吳孟書
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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
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Present illness Miss swallowing 圍棋棋子15 min ago PAT:
Appearance: easy looking Breathing: smooth, no retraction Circulation: stable PE: essentially normal
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Initial order CXR (including abdomen) Abdomen (5 min later)
Neck soft tissue lat. View (5 min later)
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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
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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
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RTC to PES OPD next day Sore throat +, drooling + => Admission
Panendoscopy removed 圍棋 smoothly Patient discharged 3 days later
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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
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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
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Initial order CXR stat Admission to PICU On O2 hood
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CXR
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ABG PH: 7.231 PCO2: 51.6 PO2: 100.3 HCO3: 21.2 SBE: -6.4 Sat: 96.4
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Flexible bronchoscope
Foreign body impacted immediately in the subglottic level with partial airway obstruction Suggestion: consult ENT doctor for extraction of foreign body
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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
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Hospital course Dexan was used for 2 days Extubation 3 days later
Discharged 4 days later
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Thanks for your attention !!
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