1. Ped case conference ~ foreign body ~~2008/06/25
Presented by : R2 沈朝賢
Supervisor : VS 吳孟書

2. Case 1. General data 年齡: 4y 性別: male Vital sign: T/P/R: 37.3/113/22
C/C: 吞食棋子, 輕度呼吸窘迫

3. Present illness Miss swallowing 圍棋棋子15 min ago PAT:
Appearance: easy looking
Breathing: smooth, no retraction
Circulation: stable
PE: essentially normal

4. Initial order CXR (including abdomen) Abdomen (5 min later)
Neck soft tissue lat. View (5 min later)

6. Another 5 min later… Dysphagia +, Nausea without vomiting
Can’t speak well, can’t drink water/ salivation +
Consult ENT =>
r/o F/B miss-swallowing
May arrange PES if indicated

7. Transfer to 林口 ER Drooling, no air way compromise Consult ENT =>
Rigid esophagoscopy is not indicated
arrange PES if symptoms persisted
MBD and OPD f/u

8. RTC to PES OPD next day Sore throat +, drooling + => Admission
Panendoscopy removed 圍棋 smoothly
Patient discharged 3 days later

10. Case 2. General data 年齡: 1y/1m 性別: female
Vital sign: T/P/R: 38.1/195/30
C/C: 吞食異物, 重度呼吸窘迫

11. Present illness SOB, tachypnea was noted; 由LMD轉入, 疑似異物
媽媽昨晚有給病人吃花生, 但不知是否有chocking
呼吸音哮吼,胸骨凹陷,皮膚顏色蒼白

12. Initial order
CXR stat
Admission to PICU
On O2 hood

13. CXR

14. ABG
PH: 7.231
PCO2: 51.6
PO2: 100.3
HCO3: 21.2
SBE: -6.4
Sat: 96.4

15. Flexible bronchoscope
Foreign body impacted immediately in the subglottic level with partial airway obstruction
Suggestion: consult ENT doctor for extraction of foreign body

16. OP note Anesthesia was done throughout bronchoscopy
Foreign body was found at subglottic region with surrounding mucosa edematous change
Foreign body (peanut) was removed into 2 pieces during operation

18. Hospital course Dexan was used for 2 days Extubation 3 days later
Discharged 4 days later

19. Thanks for your attention !!