American College of Emergency Physicians Section of Pediatric Emergency Medicine
Gregory P. Conners, MD, MPH, MBA
Children's Mercy Hospitals & Clinics; Kansas City, MO
Each of the following questions has one BEST answer.
Your colleague signs out a previously generally healthy 2-year old boy who swallowed a penny a few hours earlier, has had no complaints, and has a normal physical exam. He is awaiting a chest radiograph. Appropriate questions to ask your colleague include:
The film comes back and is read by a radiologist as "Disc shaped radiopaque foreign body in mid-abdomen. Clinical correlation suggested." You agree - the penny is in the small intestine. Appropriate next steps include:
The parent remembers having read something in Time Magazine about pennies "burning a hole in the stomach." Safe and accurate responses include:
The next day, a husky 7-year old boy presents with "choking on lunch." He swallowed half a hot dog with minimal chewing, and felt it get stuck in his throat. He tried drinks, but cannot swallow them. He is drooling and uncomfortable but not in great pain or distress. A radiograph shows a vague upper esophageal mass. Appropriate management includes:
A teenage girl gets so upset after an argument with her parents that she impulsively swallows a button/disk battery at 2:00 AM. A 3:30 AM radiograph reveals the battery in the mid-esophagus. She is tearful but cooperative. Appropriate management includes:
A previously generally healthy nine-year-old boy, while touring his father's factory workplace, decided to show off a bit, and put a small piece of aluminum in his mouth. He then accidentally swallowed it. His father brought him to the Emergency Department because he complained of feeling like it was stuck "right here," pointing to his upper sternum, despite drinking a glass of water. He has no respiratory complaints. Suspecting it is lodged in the esophagus, you order a chest radiograph. However, the radiograph does not reveal a radiopaque foreign body. The patient continues to voice the same complaint. Appropriate management includes:
A previously healthy 4 year-old girl child had moderate chest pain for several hours. Then she was brought to the Emergency Department after a single episode of vomiting a large amount of blood. Your urgent evaluation includes a chest radiograph, which reveals a coin-shaped object in the mid-chest. The parents note that she had swallowed a nickel several weeks earlier, but had seemed fine after several minutes of gagging, so they did not seek medical care at that time. She had been otherwise generally well until today, although they note she has not been eating very well. The most important thing to realize regarding the coin is that it may be:
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