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CAUSTIC INGESTION AND FOREIGN BODIES OF THE AERODIGESTIVE TRACT. Abie Mendelsohn UCLA Head & Neck Surgery Resident Lecture Series March 25, 2009. FOREIGN BODIES. According to Chik et. al., what object together with peanuts comprises for 85% of foreign body aspirations?. FOREIGN BODIES.

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Caustic ingestion and foreign bodies of the aerodigestive tract l.jpg

CAUSTIC INGESTION AND FOREIGN BODIES OF THE AERODIGESTIVE TRACT

Abie Mendelsohn

UCLA Head & Neck Surgery

Resident Lecture Series

March 25, 2009


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FOREIGN BODIES TRACT

According to Chik et. al., what object together with peanuts comprises for 85% of foreign body aspirations?


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FOREIGN BODIES TRACT

According to Chik et. al., what object together with peanuts comprises for 85% of foreign body aspirations?

WHO CARES?????

Watermelon Seeds (in Hong Kong Children)


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FOREIGN BODIES TRACT

Cummings:

“Foreign body removal has been greatly facilitated by the introduction of foreign body extraction forceps that have a central channel for an extra-long Hopkins rod telescope. Different forceps are available to remove friable foreign bodies such as peanuts and solid material such as plastic. The use of adrenaline before any attempt at removal shrinks the mucosa and reduces bleeding.”


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FOREIGN BODIES TRACT

Or Everything else

What is it?


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FOREIGN BODIES TRACT

Radiography

PA & lateral views of chest & neck

Inspiration & expiration

Lateral decubitus views

Airway fluoroscopy

25% have normal radiography


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FOREIGN BODIES TRACT

Common esophageal locations

Cricopharyngeus

Aorta/left mainstem bronchus

Gastroesophageal junction








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FOREIGN BODIES


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Let’s do what’s best for the patient TRACT

Damn I’m tired

Get the Pediatric Anesthesiologist or I’m not coming in

FOREIGN BODIES


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FOREIGN BODIES

J of Pediatric Surg 2005. 40;7:1122-7.


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  • It’s 10:38pm the next night. children actually had foreign bodies.

  • 4 year old boy was eating watermelon, now can’t breathe too good.

  • CXR shows hyperinflated lung.

FOREIGN BODIES


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I”ll be right in, but get the patient in the room. children actually had foreign bodies.

Make Sure Everything is setup and ready to go.

FOREIGN BODIES


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FOREIGN BODIES


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FOREIGN BODIES children actually had foreign bodies.


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FOREIGN BODIES children actually had foreign bodies.


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OR children actually had foreign bodies.

FOREIGN BODIES

When to bridge….


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FOREIGN BODIES children actually had foreign bodies.


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CAUSTIC INGESTION children actually had foreign bodies.

3 year old boy arrives in ER after drinking unknown substance

What do you want to ask on history?


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CAUSTIC INGESTION children actually had foreign bodies.

Amount

Type

Concentration

Time of contact


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CAUSTIC INGESTION children actually had foreign bodies. EVIDENCE BASED

Do not order barium swallow

Will delay OR time

Can not diagnose Grade 1-2 injuries

Friedman E M. Caustic ingestions and foreign bodies in the aerodigestive tract of children. Pediatr Clin North Am 1989; 6: 1403–10.


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CAUSTIC INGESTION children actually had foreign bodies. EVIDENCE BASED

Everybody gets esophagoscopy for prognosis

Katzka D.A.: Caustic injury to the esophagus. Curr Treat Options Gastroenterol 4. (1): 59-66.2001


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CAUSTIC INGESTION children actually had foreign bodies.

Esophagoscopy in virtually all patients at 24-48 hours post-ingestion

< 24 hours – underestimation of injury

> 72 hours with risk of iatrogenic perforation – barium swallow

Endoscopy to upper limit of severe burn

Want to do anything else???


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CAUSTIC INGESTION children actually had foreign bodies.

Nasogastric tube

Prevent adherence of esophageal walls

Allow for nutrition


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CAUSTIC INGESTION children actually had foreign bodies.

Grade 1 - superficial injury

Grade 2 – transmucosal injury

Grade 3 – transmural injury

Circumferential vs. localized injury


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CAUSTIC INGESTION children actually had foreign bodies.

Goal

Preventing permanent

injury or stricture in

esophagus


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CAUSTIC INGESTION children actually had foreign bodies. EVIDENCE BASED

No benefit from steroid use

NEJM

n = 60

Prospective, Randomized, Controlled

Anderson K D, Rouse T M, Randolph J G. A controlled trial of corticosteroids in children with corrosive injury of the esophagus. N Engl J Med 1990; 323: 637.


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CAUSTIC INGESTION children actually had foreign bodies. EVIDENCE BASED

Use diluting agents

Milk

Water

Use GERD therapy

Use Antibiotics

NONE!!!


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CAUSTIC INGESTION children actually had foreign bodies.

Esophageal carcinoma

1,000x increased risk

13 to 71 years after injury

Better prognosis than usual esophageal cancer


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