Pediatric emergency medicine trisk 3269 3269

typically benign situation into a potentially emergent airway foreign body aspiration Initial Assessment A child may be witnessed placing a foreign body in the nose More commonly, the child will report what they have done to a parent or caregiver Determining what type of object was placed is important to determining approaches to removal Alternatively, when persistent nasal discharge, particularly unilaterally, is the primary complaint, gaining information about the chronicity of symptoms becomes important On physical examination, the nasal cavities may need to be suctioned to visualize if an object is present Sometimes, suctioning results in removal of the object During anterior rhinoscopy, the location of the foreign body and any other injuries should be noted Plain films are not indicated unless there is specific concern for a radio-opaque foreign body that is not identified during direct visualization Management Prior to any removal attempt, a topical nasal vasoconstricting agent such as oxymetazoline should be used to decongest the mucosa and minimize potential bleeding In the cooperative child, instruments can be used to grasp and remove the object Alternatively, a 5-French Foley catheter or commercially available device (e.g., Katz extractor) can be inserted behind the object and the balloon inflated to extract the object Young or uncooperative children may require anxiolysis or procedural sedation, although this is less common than with ear foreign bodies Otolaryngology should be consulted for long-standing foreign bodies, particularly with associated granulation tissue or concern for concurrent infection Acute and long-term management strategies will vary by case For recently placed foreign bodies, which are removed successfully, no further treatment is required For subacute or chronic foreign bodies, antibiotics are often administered after removal to prevent infections including sinusitis Children may be discharged home Caregivers should be advised that the nose may continue to have small amounts of bleeding at home When removal is not successful by emergency clinicians, otolaryngology should be consulted Subsequent removal may occur during the ED visit or in an outpatient setting Trauma to the Nose and Sinuses Goals of Treatment