Good case (I made at least a nickel)

[pd4emergence]

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Case on call the other night

3 yo swallowed a coin 3-4 days ago. Parents called RN friend who said it would pass. It didn't. Xrays showed what looked like a quarter in the proximal to mid esophagus. Kid ate some cherios about 3 hours ago. Surgeon worried about a perf and doesn't want to wait. She is a healthy kid, no problems, no family history of any anesthetic problems.

 

[zippy2u]

Get an IV in, to OR, IV induction agent without paralysis, ETT, get out coin, extubate, to PACU, have a cig. Regards, ---Zip

 

[jetproppilot]

Case on call the other night

3 yo swallowed a coin 3-4 days ago. Parents called RN friend who said it would pass. It didn't. Xrays showed what looked like a quarter in the proximal to mid esophagus. Kid ate some cherios about 3 hours ago. Surgeon worried about a perf and doesn't want to wait. She is a healthy kid, no problems, no family history of any anesthetic problems.

What Zippy said.

But have a dippa Copenhagen instead of a cig.

 

[DrDre']

Drink a triple shot mocha and run 20 miles.

What Zippy said.

But have a dippa Copenhagen instead of a cig.

 

[zippy2u]

In my dreams of a utopian society, in the PACU I would pull out my portable Ronco credit card machine, ask the parent(s) for a major credit card, swipe for $500 and then have my cig... Regards, ---Zip

 

[Noyac]

Reminds me of my very first call out of residency. 3am call from ped surg for 3yr old with nickle in the trachea just above the carina.

 

[zippy2u]

Wow Noyac, a real ball buster. IV in ER, to OR, pre ox very well, inhalational induction with sevo and O2, get really deep with 8% but keep kid breathing, no paralysis, DL and spray cords with 1cc of the LTA, hand airway over to ENT with no ETT and tell throat guy ya got a couple of minutes before I'll have to take airway back over-- no rookie a$$ shiit. get coin out, continue masking with sevo off until kid emerges in OR, to PACU, swipe card for $1000 and have 2 cigs. Regards, ----Zip

 

[coprolalia]

I seem to do this case at least once a month where I am. Usually I'm on-call and it's 3:00 AM because the parents were at WalMart or something. Yeah, I know. Some solid parenting going on out there.

I've had coins of all denomination, broken perfume bottles, pen tips, marbles (which are a friggin' byQtch and the scaries of all inhaled objects, BTW), and even a foil gum wrapper (?). I thought ALL parents taught not to give small objects to little kids. Sheesh! We do them as zippy describes.

-copro

 

[VentdependenT]

Me, being a peds hater would do the following.

If they got two views and visualized the coin in the esophagus:
IV RSI with sux, Cuffed 4.0 ett (do NOT GOOSE IT), done deal.

If nobody knows where it is, except somewhere in the kid, then I'm not putting a tube in the trachea.

Mask em down like zippster said. Then let the ENT dudes blow that vapor through their rigid bronch.

 

[johankriek]

Get an IV in, to OR, IV induction agent without paralysis, ETT, get out coin, extubate, to PACU, have a cig. Regards, ---Zip

how is that a rapid seq induction.. add an og tube to suck stomach contents out. Extubate wide awake. as usual for a child

 

[johankriek]

IV RSI with sux, Cuffed 4.0 ett (do NOT GOOSE IT), done deal.

you win dude.. give him his certificate

 

[jetproppilot]

how is that a rapid seq induction.. add an og tube to suck stomach contents out. Extubate wide awake. as usual for a child

OK dude.

I did 6 months straight of pedi anesthesia as a resident at a bustling pedi-only hospital.

"As usual?"

Thats not the only way its "usually" done in a busy, all-pedi private practice.

I like the OG tube while kid is asleep.....sukk'em out, then remove it.

But the kid doesnt have to be doing push-ups to be extubated.

Especially after gastric evacuation via OG tube while asleep.

 

[VentdependenT]

you win dude.. give him his certificate

Another one?!

I just got one for learning how to use velcro. It was about time since all my pants have that material. Got too many "things" caught in zippers over the years.

 

[zippy2u]

Well Johan, that tube'll get in the right spot within 15 seconds. You may need the paralytic, perhaps I don't. Smidgeons of lido, fent and prop in a 3 year old is all I need. Can't fault ya for a paralytic and if it was "boards time" I'd use a paralytic and perhaps in an adult. I wouldn't use cricoid pressure either in this kid, but you're welcome to do it. Bottom line, just get the tube in quickly. Regards, ----Zip

 

[pd4emergence]

Here's how I did it. No IV and any attempts to get our same day nurses to start an IV on a 3yo would be met with blank stares. 5 mg po versed and the kid did not care about anything, went to or, let her breathe a little nitrous, she did not care when the IV went in. RSI with propofol and sux. I really did not want to use sux and would not have if she had not eaten so recently. 4.0 cuffed tube. Surgeon got the nickel out after some time. Kid did fine and went home the next day to see if quarters taste any better.

 

[jetproppilot]

Here's how I did it. No IV and any attempts to get our same day nurses to start an IV on a 3yo would be met with blank stares. 5 mg po versed and the kid did not care about anything, went to or, let her breathe a little nitrous, she did not care when the IV went in. RSI with propofol and sux. I really did not want to use sux and would not have if she had not eaten so recently. 4.0 cuffed tube. Surgeon got the nickel out after some time. Kid did fine and went home the next day to see if quarters taste any better.

Nice job. 👍

Streeted the kid to resume esophageal piggy-bank career.