The removal of coins from the upper esophageal tract of children by emergency physicians: a pilot study

Abstract

Objective: There are few reports in the medical literature describing removal of a coin from the upper esophageal tract of a child by an emergency physician. However, given the nature of their training and practice, emergency physicians are well suited to perform this common procedure. We describe our experience with this procedure. Methods: This was a retrospective review of a continuous quality improvement data set from a university-based tertiary care pediatric emergency department between Nov. 1, 2003, and Mar. 31, 2004. Results: Thirteen children, with a median age of 20 months, underwent rapid sequence intubation and had coins successfully removed from their upper esophageal tract by emergency physicians. In 10 cases, the coin was visible at laryngoscopy and removed with Magill forceps. In 3 cases this approach failed and a Foley catheter was used to remove the coin. One child suffered a tonsillar abrasion and two sustained minor lip trauma, but all were extubated and discharged home from the emergency department with no significant complications. Eleven of the 13 patients were successfully followed up, and the parents reported no problems. Conclusions: This pilot study suggests that the removal of a coin from the upper esophageal tract by an emergency physician can be both safe and effective. A larger study is needed before this procedure can be generally recommended.

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

“…Emergency physicians performed attempted removal following previously published guidelines. 14 The recommendations included rapid sequence intubation (RSI) followed by direct visualization of the esophagus larygoscopically. If the coin was visible, Magill forceps were to be used.…”

“…Otherwise, a Foley catheter was to be passed beyond the coin, the balloon inflated, and the catheter withdrawn. 12,14,15 Emergency physicians recorded key data on CQI forms that included the patient's date of birth, date of visit, gender, foreign body description, immediate complications, and telephone contact information. Hospital records were reviewed to ascertain whether the patient had been transferred from another ED, key time points including the duration since coin ingestion and the duration of fasting (nihil per os) prior to the procedure, the presence of a respiratory care practitioner, medications administered, method of removal, and the timing of intubation, coin removal, extubation, and discharge from the ED.…”

“…We developed a continuous quality improvement (CQI) project and have previously published a pilot study based on the first 13 patients. 14 The objective of this article is to describe our experience with removing esophageal coins over the subsequent 4 years.…”

Evaluation of Paraclinical Methods in diagnosis of Foreign Body and its complications compared to operating room findings in patients with oral, pharyngeal and esophageal symptoms in Amir A’lam Hospital

“…Delay in diagnosis and removal may cause obstruction, deep neck abscesses, esophageal perforation and mediastinitis. 10,11 Rapid removal of the foreign body reduces the risk of perforation. Therefore, the foreign body should be removed as soon as possible by the most common method of removal of the foreign body through esophagoscopy.…”

Comparison of the Magill forceps and the Boedeker (curved) intubation forceps for removal of a foreign body in a Manikin

“…The foreign body is usually removed using Magill forceps and direct laryngoscopy (DL) [1,3]. While standard laryngoscopes provide a direct view along the line of sight (10°field of view), with videolaryngoscopy a much wider (60°) field of view may be achieved (personal communication, Karl Storz).…”