image by: Pink Sherbet Photography

HWN Suggests

CRACKCast E060 – Foreign Bodies

Tricky problem. Sometimes glaringly obvious: the arrow in the head, the electronic vibrating device in the rectum. However, sometimes we are unable to obtain an accurate history; BB in the eye, or 100 plus packets of cocaine in the GI tract of an inconspicuous patient.

Imaging Helps: Plain radiographs help with radio-opaque objects. Order two views as always so as to locate in 2 dimensions (you can’t find a house without the full address)

Don’t forget about CT and Ultrasound: Good for organic FBs and structures that are difficult to image (eg. the EYE)

read full article

Featured

 POCUS

Bedside ultrasound can help evaluate for and identify foreign bodies that are not radiopaque such as plastic, organic material, and wood

 “You Put That Where?!?!” Removal of pediatric foreign bodies

Nasal foreign bodies make up 0.1% of pediatric emergency department visits. The most common age of presentation is 2 to 4-years-old. Most patients are asymptomatic. In asymptomatic patients, the foreign body may be found when children or caregivers report a history of nasal foreign body or when complications occur. In symptomatic children, the most common symptoms are pain and discomfort. Less commonly, foul-smelling nasal discharge, persistent rhinorrhea or epistaxis can also occur.

Previously Featured

Imaging

Imaging modalities available for detecting foreign bodies include plain film radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound. Each modality has its strengths and weaknesses that vary depending on the composition material of the foreign body, as well as the object’s location.

Localization

Any patient presenting with a wound should always raise concern for a possible retained foreign body.

Airway

Children, males more often than females, as well as developmentally delayed individuals, are more likely to aspirate foreign bodies, though the elderly are also at risk.

Ear

While foreign bodies in children often include a wide range of objects such as toys, rocks, beads, crayons, and cotton swabs, foreign bodies in adults are most commonly insects.- Brooke Moungey MD

Esophageal

Esophageal foreign body impactions are a rare entity, that cause quite a bit of discomfort to patients and have the potential for esophageal necrosis and perforation - Salim Rezaie

Genitourinary

Genitourinary foreign bodies (GUFB) presenting to the emergency department (ED) often require urologic and gynecologic consultations, invasive interventions (cystoscopy, vulvoscopy, exam under anesthesia, etc.), and on occasion hospital admissions.

Intraocular Foreign Bodies (IOFB)

Apart from evidence of a ruptured globe with a positive Seidel sign or shallow anterior chamber, suspect intraocular foreign bodies in cases with an irregular pupil contour, iris transillumination defects, lens opacities or a persistent iritis - Caroline B. Pate OD

Pediatric Foreign Bodies

Common sites include the ear and nose, as well as the respiratory and GI tracts.

Rectal Foreign Bodies: Not always a Simple ED Diagnosis

Rectal Foreign Bodies: Not always a Simple ED Diagnosis

Throat

Some authors also suggest more liberal use of computed tomography (CT) scan to demonstrate the presence of foreign body around cricopharyngeus and in oesophagus. CT was reported to be superior to plain film and barium swallow, and may be a safe alternative to OGD.

A foreign body of a different kind: Pill aspiration

The diagnosis of pill aspiration is challenging. Although the patient may have a clear history of the nature and the timing of the pill aspiration, most pills are radiolucent on chest imaging and the pill itself may no longer be present at the time of bronchoscopic examination.

Nasal

Nasal foreign bodies make up 0.1% of pediatric emergency department visits. The most common age of presentation is 2 to 4-years-old. Most patients are asymptomatic - Hoi See Tsao MD

Non-traumatic Foreign Bodies of the HEENT and Esophagus

In general, any pediatric foreign body in the esophagus is considered impacted and requires removal as soon as possible.

Seeking Pleasure, Suffering Pain

The true incidence of rectal foreign bodies is not known, as many patients do not seek medical attention or management is underreported for obvious reasons. The emergency physician should be aware of the different techniques for removal and appreciate when to consult their general surgery colleagues.

Soft Tissues

Maintain a high suspicion for foreign body in evaluation of all wounds - Maintain a high suspicion for foreign body in evaluation of all wounds - Christopher Creech MD

The Elusive Foreign Body: A Case Report

Foreign body aspiration is a frequent complaint in the ED. Finding the culprit, however, is not always straightforward.

Resources

Eye

Corneal foreign bodies account for the second most common form of ocular trauma, with corneal abrasions being number one. In general, major morbidity such as visual acuity loss is not common. Many corneal foreign bodies are superficial and benign, albeit uncomfortable - Anthony J. Camodeca