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Foreign Body Ingestion — Coins/Blunt Objects Confirmed on X-Ray — Clinical Pathway: Emergency, ICU and Inpatient

Pathway for the Evaluation/Treatment of the Child with Foreign Body Ingestion

Coins/Blunt Objects Confirmed on X-Ray
Consider composition of FB, potential for toxicity,
Lead Containing FB
 
Esophagus
Symptoms
No Symptoms
Consult
  • ENT: Proximal to mid-esophagus
  • GI: Distal esophagus
  • General Surgery: Hx of esophageal surgery
Emergent Endoscopic Removal
Urgent
Endoscopic Removal
NPO, IVF
Alert OR 5-4444
Admit EDECU, ENT, or GI
NPO, IVF
Repeat X-ray before
endoscopic removal
Stomach
Beyond Stomach
Symptoms
No Symptoms
Symptoms
Consult GI
Discharge
Items in Stomach
  • Repeat X-ray as
    clinically indicated
  • Cylindrical battery
    • Repeat X-ray 3-4 days
  • Note: Width > 2 cm,
    length > 5 cm, less likely to pass pylorus/duodenum
  • Items Beyond Stomach
  • Will likely pass
  • Return if symptomatic
Consider alternative diagnoses
Consult General Surgery as needed
Glucagon
In special circumstances, may be considered for FB at the lower esophageal sphincter after consult with GI.
Glucagon IV dose: 0.025mg/kg/dose, max 0.5 mg
Coins may appear larger on X-ray
Quarter 24 mm
Nickel 21 mm
Penny 19 mm
Dime 18 mm
 
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