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2.
BMJ Case Rep ; 14(8)2021 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-34400422

RESUMO

Foreign body (FB) in the external auditory canal is more common among the paediatric age group compared with adult patients and it may be deposited in various ways. An accidental animate aural FB is reported to be commonly encountered in adults whereas inanimate FBs are likely to be found among adult patients with learning disability. An elderly man presented with accidental penetration of rattan tree stem into his ear while gardening. Removal of a FB from the external auditory canal requires expertise as deep penetration of a FB into the middle and inner ear may lead grave complications, especially when overzealous removal is attempted by nonear, nose and throat (ENT) personnel. This case emphasises on the importance of awareness of meticulous removal of a FB under proper visualisation so as to avoid unnecessary complications. Additionally, we propose an algorithm for proper removal of aural FB in an acute care setting.


Assuntos
Orelha Interna , Corpos Estranhos , Adulto , Idoso , Algoritmos , Criança , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/terapia , Humanos , Masculino , Faringe , Estudos Retrospectivos
3.
Adv Emerg Nurs J ; 43(3): 198-205, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34397496

RESUMO

A 9-year old male presented to the emergency department for the evaluation of a sore throat. Initial history of present illness stated in the triage note was that "the child complained of a sore throat," suggesting possible pharyngitis. There was no evidence of stridor, sialorrhea, hypoxia, or aphonia. Further investigation of the history of present illness identified the concern for a possible esophageal foreign body. Imaging studies of the neck identified a fishbone in the esophagus. This case presentation discusses an atypical presentation of an esophageal foreign body and the subtle findings on assessment and imaging. This case highlights the importance of illiciting a history of present illness and the subtleties of esophageal foreign body identification.


Assuntos
Osso e Ossos , Corpos Estranhos/diagnóstico por imagem , Faringite/diagnóstico por imagem , Faringite/etiologia , Animais , Criança , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Esofagoscopia , Peixes , Corpos Estranhos/terapia , Humanos , Masculino , Faringite/terapia
4.
J Laryngol Otol ; 135(9): 825-828, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34348802

RESUMO

OBJECTIVE: This case series, conducted during the coronavirus disease 2019 pandemic, investigates the impact of leaving aural foreign bodies in situ for a prolonged period of time, including the risk of complications and success rates of subsequent removal attempts. METHOD: A retrospective study of aural foreign body referrals over a six-month period was carried out. RESULTS: Thirty-four patients with 35 foreign bodies were identified (6 organic and 29 inorganic). The duration of foreign bodies left in situ ranged from 1 to 78 days. Four patients suffered from traumatic removal upon initial attempts. First attempts made by non-ENT specialists (68.8 per cent) all failed and were associated with a high risk of trauma (36.4 per cent). CONCLUSION: Because of the coronavirus disease 2019 pandemic, this is the first case series to specifically investigate the relationship between the duration of aural foreign bodies left in situ and the risk of complications. Our data suggest that prolonged duration does not increase the incidence of complications.


Assuntos
COVID-19/epidemiologia , Meato Acústico Externo , Corpos Estranhos/terapia , Tempo para o Tratamento , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/complicações , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Corpos Estranhos/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Tempo para o Tratamento/estatística & dados numéricos , Adulto Jovem
5.
J Laryngol Otol ; 135(9): 829-833, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34348818

RESUMO

OBJECTIVE: This study investigated how the coronavirus disease 2019 pandemic has impacted on presentations to ENT first-on-call services. METHODS: All appointments to a rapid access triage clinic from 1 June to 31 August in 2019 and 2020 were reviewed retrospectively and their reasons for consultation classified. A binomial proportion test was used to determine whether the proportions of consultations per presentation differed significantly between years. This analysis was repeated with the number of unique patients per presenting complaint. RESULTS: The proportions of nine reasons for consultation differed significantly between 2019 and 2020, including an increase in otitis media and nasal trauma presentations, and a decrease in otitis externa and tonsillitis presentations. Reattendances caused some variation in the frequency of certain diagnoses. CONCLUSION: Our data suggest a shift in the presentations to first-on-call services, which may be a result of changes in patient behaviour and access to healthcare services.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , COVID-19/epidemiologia , Otorrinolaringopatias/epidemiologia , Orelha/lesões , Corpos Estranhos/epidemiologia , Corpos Estranhos/terapia , Humanos , Otite Externa/epidemiologia , Otite Externa/terapia , Otite Média/epidemiologia , Otite Média/terapia , Otorrinolaringopatias/diagnóstico , Otorrinolaringopatias/terapia , Estudos Retrospectivos , Tonsilite/epidemiologia , Tonsilite/terapia , Reino Unido/epidemiologia
6.
J Laryngol Otol ; 135(8): 746-748, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34266517

RESUMO

BACKGROUND: Ingested foreign bodies are a common presentation to paediatric ENT services. Depending on the site, these are usually managed with flexible or rigid oesophagoscopy and retrieval. This paper presents a novel technique for removing a hollow foreign body that could not be removed using conventional means. METHOD AND RESULTS: After rigid and flexible approaches failed, a guidewire was passed through the foreign body under fluoroscopic guidance and a dilatation balloon passed through the lumen of the object. Inflating the balloon allowed dilatation of the inflamed mucosa above and below the object, facilitating straightforward removal under traction. CONCLUSION: This is a novel and reproducible technique that uses equipment readily available in tertiary referral centres. Employed in this context, the technique enabled removal of an impacted object surrounded by granulation tissue, and would be appropriate for other objects with a lumen.


Assuntos
Dilatação/métodos , Esôfago , Corpos Estranhos/terapia , Esôfago/diagnóstico por imagem , Fluoroscopia , Corpos Estranhos/diagnóstico por imagem , Gastroscopia , Humanos , Lactente , Radiografia
8.
BMC Emerg Med ; 21(1): 85, 2021 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-34289808

RESUMO

OBJECTIVE: To explore the role of a first-aid fast track channel in rescuing children with airway foreign bodies and to analyse and summarize the experience and lessons of the first-aid fast track channel in rescuing airway foreign bodies from patients in critical condition. METHODS: We retrospectively reviewed the medical records of children with airway foreign bodies rescued by first-aid fast track channels admitted to our hospital from January 2017 to December 2020. The corresponding clinical features, treatments, and prognoses were summarized. RESULTS: Clinical data from 21 cases of first-aid fast track channel patients were retrospectively collected, including 12 males and 9 females aged 9-18 months. Cough was the most frequently exhibited symptom (100.0%), followed by III inspiratory dyspnoea (71.4%). Regarding the location of foreign bodies, 5 cases (23.8%) had glottic foreign bodies, 10 cases (47.6%) had tracheal foreign bodies, and 6 cases (28.6%) had bilateral bronchial foreign bodies. The most common type of FB was organic. FB removal was performed by rigid bronchoscopy in every case, and there were no complications of laryngeal oedema, subcutaneous emphysema, or pneumothorax. No tracheotomy was performed in any of the children. CONCLUSION: The first-aid fast track channel for airway foreign bodies saves a valuable time for rescue, highlights the purpose of rescue, improves the success rate of rescue and the quality of life of children, and is of great value for the treatment of critical tracheal foreign bodies. It is necessary to regularly summarize the experience of the first-aid fast track channel of airway foreign bodies and further optimize the setting of the first-aid fast track channel.


Assuntos
Primeiros Socorros , Corpos Estranhos , Brônquios , Estado Terminal , Feminino , Corpos Estranhos/terapia , Humanos , Lactente , Masculino , Qualidade de Vida , Estudos Retrospectivos
11.
Medisur ; 19(3): 524-529, 2021. graf
Artigo em Espanhol | LILACS | ID: biblio-1287334

RESUMO

RESUMEN: La ingestión intencional de cuerpos extraños es frecuente entre prisioneros. Es un fenómeno asociado a un aumento de la morbimortalidad y los costos. Generalmente no requiere de intervención específica, aunque pueden aparecer complicaciones severas, que requieren, en ocasiones, tratamiento quirúrgico urgente. Se presenta un paciente masculino, de 24 años de edad, sin antecedentes relevantes, recluido en la prisión de máxima seguridad de la provincia Camagüey. Se introdujo por la boca un alambre de 40 cm de longitud, con un gancho en su punta. Presentó sialorrea y molestias retroesternales. Al examen físico se encontró normalidad de sus parámetros vitales, sin alteraciones en el examen del tórax, con abdomen doloroso a la palpación profunda del cuadrante inferior derecho. Se realizaron radiografías simples de tórax posteroanterior, lateral, y de abdomen simple, se encontraron un cuerpo extraño desde la boca hasta el tercio inferior del esófago torácico y otro cuerpo extraño ubicado en la pelvis, que refirió haber ingerido intencionalmente hace un año. Se realizó laparotomía urgente y extracción de ambos cuerpos extraños. El paciente evolucionó satisfactoriamente sin desarrollar complicaciones. La ingestión intencional de cuerpos extraños en la población penal es un problema de salud complejo. La prevención es uno de los pilares fundamentales de su tratamiento. Es importante un alto índice de sospecha sobre la ingestión de múltiples objetos, en este grupo de pacientes la cirugía es frecuentemente requerida.


ABSTRACT The conscious ingestion of foreign bodies is frequent among prisoners. It is a phenomenon associated with an increase in morbidity - mortality and costs. Generally, it does not require specific intervention, although severe complications may appear, which sometimes require urgent surgical treatment.to present the case of a prisoner with recurrent intentional ingestion of multiple foreign bodies, one of them not previously diagnosed. Case presentation: A 24-years-old male patient, with no relevant history, held in the Camagüey province maximum security prison. The wire was introduced through the mouth 40 cm long, with a hook at its tip. Referring to hypersalivation and retrosternal discomfort. The physical examination found normality of his vital parameters, without alterations in the chest examination, with a painful abdomen on deep palpation of the right lower quadrant. A posteroanterior and lateral chest X-ray was performed, finding a foreign body from the mouth to the lower third of the thoracic esophagus, an abdominal X-ray where another foreign body was located in the pelvis, which he reported having intentionally ingested a year ago. An urgent laparotomy was performed and both foreign bodies were removed. The patient evolves satisfactorily without developing complications. The intentional ingestion of foreign bodies in the prison population is a complex health problem. Prevention is one of the fundamental pillars of its treatment. A high index of suspicion on the ingestion of multiple objects is important; in this group of patients surgery is frequently required.


Assuntos
Humanos , Masculino , Adulto , Prisioneiros/psicologia , Raios X , Custos e Análise de Custo , Corpos Estranhos/complicações , Exame Físico , Indicadores de Morbimortalidade , Corpos Estranhos/terapia
13.
J Endovasc Ther ; 28(3): 474-480, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33855876

RESUMO

PURPOSE: Intravascular embolization of hemodialysis and central venous catheters is a rare but potentially serious complication. With the increasing use of catheters in medical practice, we are often faced with this type of complication. Novel, simple, and low-cost techniques are needed for foreign body extraction in order to reduce cardiovascular risks. CASE REPORT: We describe the approach of 5 foreign body embolization cases. Case 1: a 57-year-old woman with end-stage renal failure with a complete fracture and migration of the distal extremity of a hemodialysis catheter. Case 2: a 55-year-old man with an accidental embolization of the distal portion of a hemodialysis catheter. Case 3: a 76-year-old woman with stage IV breast cancer and an accidental embolization of a central venous catheter guidewire. Cases 4 and 5: a 71-year-old woman and a 2-year-old boy with a port-a-cath embolization. All the patients underwent successful minimally invasive removal of the foreign bodies from the thoracic site using 5Fr pigtail catheters. Additional surgery was not required. No further complications, such as damage to the vascular wall, were noted. CONCLUSION: Our experience with the interlacing and traction pigtail show that it is a simple, practical, and low-cost technical alternative and its benefits should be widespread.


Assuntos
Corpos Estranhos , Migração de Corpo Estranho , Idoso , Cateteres de Demora , Pré-Escolar , Remoção de Dispositivo , Falha de Equipamento , Feminino , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/terapia , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Migração de Corpo Estranho/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
14.
Medicine (Baltimore) ; 100(14): e25455, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832154

RESUMO

RATIONALE: An impacted foreign body (FB) in the larynx of an adult is a rare but potentially life-threatening occurrence. Patients with Down's syndrome (DS) are vulnerable to airway FB. However, the anesthesia for FB removal can be challenging. This report describes a case in which a FB was impacted between the vestibular folds in an adult with DS, congenital heart disease, and a difficult airway. PATIENT CONCERNS: A 41-year-old woman swallowed a piece of sharp-tipped wooden skewer presented with a sudden onset of aphonia, dysphagia, and an acute sore throat without respiratory difficulty. The patient had DS, congenital heart disease, pulmonary arterial hypertension, and severe obstructive sleep apnea-hypopnea syndrome. The airway evaluation indicated that ventilation and intubation would be difficult due to retrognathia, macroglossia, adenotonsillar hypertrophy, and Mallampati's classification III. DIAGNOSIS: The clinical symptoms and laboratory examination confirmed FB penetrated between the vestibular folds. INTERVENTIONS: After careful multidisciplinary preoperative assessment and preparation, the FB was removed successfully by direct laryngoscopy under moderate sedation and spontaneous ventilation, with the application of 1% lidocaine as topical anesthesia. OUTCOMES: The laryngeal FB was removed successfully without any complications. And the patient was discharged home the next day. LESSONS: This case report shows the importance of anesthetic depth for laryngeal FB removal. The use of moderate sedation (allowing spontaneous ventilation) and adequate analgesia combined with local anesthesia enabled the patient to withstand the stress of direct laryngoscopy. Appropriate assessment, careful preparation, and multidisciplinary collaboration yielded the smooth removal of a laryngeal FB in an adult with DS.


Assuntos
Síndrome de Down/complicações , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/terapia , Cardiopatias Congênitas/complicações , Laringoscopia/métodos , Laringe/diagnóstico por imagem , Adulto , Feminino , Humanos
15.
J Paediatr Child Health ; 57(6): 867-871, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33719140

RESUMO

AIM: To describe variation in the initial management of children presenting to Emergency Departments (ED) with coins lodged in the oesophagus. To determine the usage of hand-held metal detectors (HHMDs) in EDs, including their role in clinical decision-making, and training in their use. METHODS: Online multicentre cross-sectional survey of EDs in the UK and Ireland, with results described using descriptive statistics. RESULTS: Fifty-five (90%) of 61 sites responded. The two main strategies described for lodged oesophageal coins were endoscopic removal or observation with reassessment, dependent on location. For coins in the proximal third of the oesophagus 43/55 (78.2%) referred for endoscopic removal, 6/55 (10.9%) observed and the remaining 10.9% used a variety of methods, including: Foley catheter removal with fluoroscopy, blind Foley catheter removal, referral to paediatric surgery/ENT. Thirty (55%) of 55 used HHMDs, 21/30 (70%) had guidelines for their use, and 3/30 (10%) provided formal training. Twenty (67%) of 30 used the xiphisternum as the anatomical cut-off for assuming safe passage of metallic foreign bodies (FB) beyond the lower oesophageal sphincter. CONCLUSIONS: There is considerable variation in the management of oesophageal coins in children, though two dominant strategies were identified. As endoscopy is significantly more invasive than observation, future research should aim to determine whether either is more effective and safer in children. There is a clear division in departmental adoption of HHMDs. However, in those sites using HHMDs there was little formal training in their use, and there are large variations in techniques and their role in clinical decision-making.


Assuntos
Corpos Estranhos , Criança , Estudos Transversais , Ingestão de Alimentos , Serviço Hospitalar de Emergência , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/terapia , Humanos , Lactente , Irlanda , Reino Unido
17.
J Laryngol Otol ; 135(2): 117-124, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33612142

RESUMO

BACKGROUND: Coronavirus disease 2019 imposed dramatic changes on ENT service delivery. Pre-pandemic, such changes would have been considered potentially unsafe. This study outlines the impact of lockdown on the incidence and management of ENT emergencies at a large UK centre. METHODS: After modification of pre-pandemic guidelines, ENT emergency referrals data during the UK lockdown were prospectively captured. A comparative analysis was performed with retrospective data from a corresponding period in 2019. RESULTS: An overall reduction (p < 0.001) in emergency referrals (n = 119) and admissions (n = 18) occurred during the lockdown period compared to the 2019 period (432 referrals and 290 admissions). Specifically, there were reduced admission rates for epistaxis (p < 0.0001) and tonsillar infection (p < 0.005) in the lockdown period. During lockdown, 90 per cent of patients requiring non-dissolvable nasal packing were managed as out-patients. CONCLUSIONS: Coronavirus disease 2019 compelled modifications to pre-pandemic ENT guidelines. The enforced changes to emergency care appear to be safe and successfully adopted. Arguably, the measures have both economic and patient-related implications post-coronavirus disease 2019 and during future similar pandemics and lockdowns.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , COVID-19 , Epistaxe/terapia , Hospitalização/estatística & dados numéricos , Abscesso Peritonsilar/terapia , Tonsilite/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Orelha , Otopatias/epidemiologia , Otopatias/terapia , Emergências , Serviço Hospitalar de Emergência , Epistaxe/epidemiologia , Feminino , Corpos Estranhos/epidemiologia , Corpos Estranhos/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Otorrinolaringopatias/epidemiologia , Otorrinolaringopatias/terapia , Abscesso Peritonsilar/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/tendências , SARS-CoV-2 , Tonsilite/epidemiologia , Reino Unido/epidemiologia , Adulto Jovem
19.
J Laryngol Otol ; 135(3): 250-254, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33632367

RESUMO

BACKGROUND: By nature of their specialty, otolaryngologists are disproportionately exposed to coronavirus disease 2019 through aerosol-generating procedures and close proximity to the oropharynx during examination. METHODS: Our single-centre, retrospective study analysed the pertinence of guidelines produced by ENT UK to improve the investigation and management of suspected upper aerodigestive fish bone foreign bodies during the coronavirus disease 2019 pandemic. RESULTS: Our results demonstrated 43.3 per cent (n = 13) low-risk cases and 56.7 per cent (n = 17) moderate-risk cases. Nine fish bones (two low risk, seven moderate risk) were found; none of these were confirmed with X-ray and three (moderate risk) required nasoendoscopy for diagnosis. One patient required rigid pharyngoscopy. CONCLUSION: This study confirms that soft tissue neck X-ray and flexible nasoendoscopy are unnecessary in low-risk cases; however, early nasoendoscopy in higher suspicion cases is appropriate. Recommendations are made about the long-term sustainability of these guidelines, and additional measures are encouraged that relate to repeat attendances and varying prevalence of coronavirus disease 2019 in the hospital catchment area.


Assuntos
COVID-19/epidemiologia , Endoscopia , Corpos Estranhos/diagnóstico , Corpos Estranhos/terapia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Orofaringe , Adulto , Animais , Osso e Ossos , COVID-19/prevenção & controle , COVID-19/transmissão , Feminino , Peixes , Humanos , Masculino , Equipamento de Proteção Individual , Estudos Retrospectivos , Alimentos Marinhos , Reino Unido
20.
Eur Arch Otorhinolaryngol ; 278(10): 3613-3623, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33417148

RESUMO

PURPOSE: Food bolus and oesophageal foreign bodies are a common presentation that may be managed by otolaryngologists, gastroenterologists, acute medicine physicians and accident and emergency. The condition is highly variable with presentations ranging from well patients whose obstruction spontaneously passes to peri-arrest with severe aspiration or impending airway compromise. Management of this condition is heterogeneous and often depends on the specialty the patient is originally admitted under. There exist European and American guidelines from the perspective of gastroenterology, but there are no UK-based guidelines and limited consideration of the role of the otolaryngologists and rigid oesophagoscopy. METHODS: An extensive literature search was carried out to generate conclusions on key management questions for food bolus and oesophageal foreign bodies. This was then summarised into both a written summary of the evidence and a graphical decision tree. RESULTS: This paper is a review article and presents conclusions regarding management options for food bolus and oesophageal foreign bodies. CONCLUSION: This article considers the current evidence surrounding investigation and management of oesophageal food bolus and foreign body. It draws conclusions regarding presentation, investigation and subsequent operative treatment. As part of this process, we propose a graphical decision tree to assist in management decisions.


Assuntos
Esôfago , Corpos Estranhos , Serviço Hospitalar de Emergência , Esofagoscopia , Esôfago/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/terapia , Humanos
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