Pathway for the Evaluation/Treatment of the Child with Foreign Body Ingestion
Coins/Blunt Objects Confirmed on X-Ray
Main Pathway
Foreign Body
Ingestion Pathway
Foreign Body
Ingestion Pathway
Consider composition of FB, potential for toxicity,
Lead Containing FB
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
Endoscopic Removal
NPO, IVF
Alert OR 5-4444
Alert OR 5-4444
Admit EDECU, ENT, or GI
NPO, IVF
Repeat X-ray before
endoscopic removal
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
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
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 |