Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-02T23:01:41.921Z Has data issue: false hasContentIssue false

Esophageal coin removal by emergency physicians: a continuous quality improvement project incorporating rapid sequence intubation

Published online by Cambridge University Press:  11 May 2015

Rishi Bhargava*
Affiliation:
Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Loma Linda Medical University Medical Center and Children's Hospital, Loma Linda, CA
Lance Brown
Affiliation:
Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Loma Linda Medical University Medical Center and Children's Hospital, Loma Linda, CA
*
Loma Linda Medical University Medical Center and Children's Hospital, 11234 Anderson Street, A-108, Loma Linda, CA 92354; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

The objective of this study was to describe our experience removing esophageal coins from children in a tertiary care pediatric emergency department over a 4-year period.

Methods:

We retrospectively reviewed a continuous quality improvement data set spanning October 1, 2004, through September 30, 2008.

Results:

In 96 of 101 cases (95%), emergency physicians successfully retrieved the coin. The median age of the children was 19 months (interquartile range [IQR] 13–43 months; range 4 months–12.8 years). The median time to removal of coin from initiation of intubation was 8 minutes (IQR 4–14 minutes; range 1–60 minutes). Coins were extracted using forceps only in 56 cases, whereas forceps and a Foley catheter were used in the remainder. Succinylcholine and etomidate were used in almost all cases for rapid sequence intubation prior to coin removal. Complications were identified in 46 cases: minor bleeding (13), lip laceration (7), multiple attempts (5), hypoxia (3), accidental extubation (3), dental injuries (3), bradycardia (2), coin advanced (1), right main-stem bronchus intubation (1), and other (8).

Conclusions:

Emergency physicians successfully removed esophageal coins following rapid sequence intubation in most cases. Our approach may be considered for the management of pediatric esophageal coins, particularly in an academic pediatric emergency department.

Type
Original Research • Recherche originale
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

References

REFERENCES

1.Bronstein, AC, Spyker, DA, Cantilena, LR Jr, et al. 2006 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS). Clin Toxicol (Phila) 2007;45:815917.Google Scholar
2.Cheng, W, Tam, PK. Foreign-body ingestion in children: experience with 1,265 cases. J Pediatr Surg 1999;34:1472–6.Google Scholar
3.Soprano, JV, Fleisher, GR, Mandl, KD. The spontaneous passage of esophageal coins in children. Arch Pediatr Adolesc Med 1999;153:1073–6.Google Scholar
4.Sharieff, GQ, Brousseau, TJ, Bradshaw, JA, et al. Acute esophageal coin ingestions: is immediate removal necessary? Pediatr Radiol 2003;33:859–63.Google Scholar
5.Hostetler, MA, Barnard, JA. Removal of esophageal foreign bodies in the pediatric ED: is ketamine an option? Am J Emerg Med 2002;20:96–8.Google Scholar
6.Mahafza, TM. Extracting coins from the upper end of the esophagus using a Magill forceps technique. Int J Pediatr Otorhinolaryngol 2002;62:37–9.CrossRefGoogle ScholarPubMed
7.Conners, GP. A literature-based comparison of three methods of pediatric esophageal coin removal. Pediatr Emerg Care 1997;13:154–7.Google Scholar
8.Tucker, JG, Kim, HH, Lucas, GW. Esophageal perforation caused by coin ingestion. South Med J 1994;87:269–72.Google Scholar
9.Macpherson, RI, Hill, JG, Othersen, HB, et al. Esophageal foreign bodies in children: diagnosis, treatment, and complications. AJR Am J Roentgenol 1996;166:919–24.Google Scholar
10.Bacli, AE, Eren, S, Eren, MN. Esophageal foreign bodies under cricopharyngeal level in children: an analysis of 1116 cases. Interact Cardiovasc Thorac Surg 2004;3:14–8.Google Scholar
11.Janik, JE, Janik, JS. Magill forceps extraction of upper esophageal coins. J Pediatr Surg 2003;38:227–9.Google Scholar
12.Mason, SM. Pharyngeal coin removal in children. J Accid Emerg Med 1997;14:175–6.Google Scholar
13.Calkins, CM, Christians, KK, Sell, LL. Cost analysis in the management of esophageal coins: endoscopy versus bougienage. J Pediatr Surg 1999;34:412–4.CrossRefGoogle ScholarPubMed
14.Vargas, EJ, Mody, AP, Kim, TY, et al. The removal of coins from the upper esophageal tract of children by emergency physicians: a pilot study. CJEM 2004;6:434–40.CrossRefGoogle ScholarPubMed
15.Schunk, JE, Harrison, AM, Corneli, HM, et al. Fluoroscopic Foley catheter removal of esophageal foreign bodies in children: experience with 415 episodes. Pediatrics 1994;94:709–14.Google Scholar
16.Random.org. Integer generator. Available at: http://www.random.org/integers/. (accessed April 27, 2010).Google Scholar
17.Gilbert, EH, Lowenstein, SR, Koziol-McLain, J, et al. Chart reviews in emergency medicine research: where are the methods? Ann Emerg Med 1996;27:305–8.Google Scholar
18.Emslander, HC, Bonadio, W, Klatzo, M. Efficacy of esophageal bougienage by emergency physicians in pediatric coin ingestion. Ann Emerg Med 1996;27:726–9.Google Scholar
19.Arms, JL, Mackenberg-Mohn, MD, Bowen, MV, et al. Safety and efficacy of a protocol using bougienage or endoscopy for the management of coins acutely lodged in the esophagus: a large case series. Ann Emerg Med 2008;51:367–72. [Epub 2007 Oct 15].Google Scholar
20.Betz, JS, Hampers, LC. Cecal retention of a swallowed penny mimicking appendicitis in a healthy 2 year old. Pediatr Emerg Care 2004;20:525–7.Google Scholar
21.Bigler, FC. The use of a Foley catheter for removal of blunt foreign bodies from the esophagus. J Thorac Cardiovasc Surg 1966;51:759–60.CrossRefGoogle Scholar
22.Brown, LP. Blind esophageal coin removal using a Foley catheter. Arch Surg 1968;96:931–2.CrossRefGoogle ScholarPubMed
23.Cetinkursun, S, Sayan, A, Demirbag, S, et al. Safe removal of upper esophageal coins by using Magill forceps: two centers’ experience. Clin Pediatr (Phila) 2006;45:71–3.CrossRefGoogle ScholarPubMed
24.Amin, MR, Buchinsky, FJ, Gaughan, JP, et al. Predicting outcome in pediatric coin ingestion. Int J Pediatr Otorhinolaryngol 2001;59:201–6.Google Scholar
25.Dahshan, AH, Kevin Donovan G. Bougienage versus endoscopy for esophageal coin removal in children. J Clin Gastroenterol 2007;41:454–6.CrossRefGoogle ScholarPubMed
26.Jona, JZ, Glicklich, M, Cohen, RD. The contraindications for blind esophageal bouginage for coin ingestion in children. J Pediatr Surg 1988;23:328–30.CrossRefGoogle ScholarPubMed