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

Title

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

Creator

Bhargava R; Brown L

Publisher

Canadian Journal Of Emergency Medical Care

Date

2011

Subject

Child; Female; Humans; Male; Time Factors; Preschool; infant; retrospective studies; Emergency Medicine/methods; Quality improvement; Esophagus/injuries; Foreign Bodies/surgery; Intubation/methods; Numismatics

Description

OBJECTIVE: The objective of this study was to describe our experience removing esophageal coins from children in a tertiary care pediatric emergency department over a 4-year period. METHODS: We retrospectively reviewed a continuous quality improvement data set spanning October 1, 2004, through September 30, 2008. RESULTS: In 96 of 101 cases (95%), emergency physicians successfully retrieved the coin. The median age of the children was 19 months (interquartile range [IQR] 13-43 months; range 4 months-12.8 years). The median time to removal of coin from initiation of intubation was 8 minutes (IQR 4-14 minutes; range 1-60 minutes). Coins were extracted using forceps only in 56 cases, whereas forceps and a Foley catheter were used in the remainder. Succinylcholine and etomidate were used in almost all cases for rapid sequence intubation prior to coin removal. Complications were identified in 46 cases: minor bleeding (13), lip laceration (7), multiple attempts (5), hypoxia (3), accidental extubation (3), dental injuries (3), bradycardia (2), coin advanced (1), right main-stem bronchus intubation (1), and other (8). CONCLUSIONS: Emergency physicians successfully removed esophageal coins following rapid sequence intubation in most cases. Our approach may be considered for the management of pediatric esophageal coins, particularly in an academic pediatric emergency department.

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Type

Journal Article

Citation List Month

Backlog

Pages

28-33

Issue

1

Volume

13

Citation

Bhargava R; Brown L, “Esophageal coin removal by emergency physicians: a continuous quality improvement project incorporating rapid sequence intubation,” Pediatric Palliative Care Library, accessed October 25, 2021, https://pedpalascnetlibrary.omeka.net/items/show/11525.

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