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IntroductionForeign body aspiration is a common cause of respiratory distress in pediatrics, but the diagnosis can be challenging given aspirated objects are mostly radiolucent on chest radiographs and there is often no witnessed choking event. We present a case of a patient who was initially managed as severe status asthmaticus, requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for refractory hypercarbia and hypoxemia, but was later found to have bilateral bronchial foreign body aspiration. This case is unique in its severity of illness, diagnostic dilemma with findings suggesting a more common diagnosis of asthma, and use of ECMO as a bridge to diagnosis and recovery.Patient caseA previously healthy 2-year-old boy presented during peak viral season with a 3-day history of fever, cough, coryza, and increased work of breathing over the prior 24 h. There was no reported history of choking or aspiration. He was diagnosed with asthma and treated with bronchodilator therapy. Physical examination revealed pulsus paradoxus, severe work of breathing with bilateral wheeze, and at times a silent chest. Chest radiographs showed bilateral lung hyperinflation. Following a brief period of stability on maximum bronchodilator therapies and bilevel positive pressure support, the patient had a rapid deterioration requiring endotracheal intubation, with subsequent cannulation to VA-ECMO. A diagnostic flexible bronchoscopy was performed and demonstrated bilateral foreign bodies, peanuts, in the right bronchus intermedius and the left mainstem bronchus. Removal of the foreign bodies was done by rigid bronchoscopy facilitating rapid wean from VA-ECMO and decannulation within 24 h of foreign body removal.ConclusionForeign body aspiration should be suspected in all patients presenting with atypical history and physical examination findings, or in patients with suspected common diagnoses who do not progress as expected or deteriorate after a period of stability. Extracorporeal life support can be used as a bridge to diagnosis and recovery in patients with hemodynamic or respiratory instability.

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Aims Whilst a centralised model of care intuitively makes sense and is advocated in other subspecialty areas of medicine, there is a paucity of supportive evidence for General Paediatrics. Following ward restructuring at our tertiary paediatric centre in preparation for the COVID‐19 pandemic, a new dedicated General Paediatrics ward was established. We evaluated medical and nursing staff well‐being, morale and perceived impacts on care after the ward's establishment. Methods Experiences were sought from medical and nursing staff whom had worked across both previous wards caring for General Paediatrics patients, as well as the new dedicated General Paediatrics ward. Mandated responses used the format of much better, better, same, worse and much worse. Results A total of 73/82 (89%) medical and nursing staff completed the survey. A greater than 90% improved or neutral response was noted for 31/35 (89%) questions. About 80% of staff reported the new dedicated General Paediatrics ward provided a better or much better team‐based approach, time efficient approach and overall model of care. A much better or better response was reported for communication between medical and nursing staff in 68%, team comradery in 69%, supportive/helpful nursing staff in 74%, job stress level in 66% and staff morale in 60% of respondents. Conclusions Overwhelmingly positive responses from this study support a centralised or “home” ward model of care for General Paediatrics patients in a tertiary paediatric setting. Our findings may be relevant to General Paediatrics teams in other centres currently using multiple wards to manage their patients.