I think not! When in doubt, the safest route is to take a look. I think that the standard of care
for this child would be to have a bronch. I have had a similar kid that ended up with another FB
in the rt main stem bronchus. This child (22 month old) had a definite past history of wheezing
but had absolutely no symptoms prior to the event. As I recall, this child had bilateral wheezing
slightly more on the rt than the left.
I think the only time that we as Peds ER physicians have a hard time having kids bronched is when
the ENT on call has not had a lot of Pediatric exposure. I don't think that Xrays are necessary
since a lack of suggestive findings would not prevent me from recommending a bronch in such a
kid. Certainly, if one had findings on an Xray (plain/I:E/decubitus), that might be a factor in
convincing a reluctant ENT to bronch.
The Pulmonary specialists will sometimes watch these kids overnight with bronchodilators and
steroids on board and if no improvement in 8-12 hours, then have ENT bronch them.
What was the outcome of observation for your patient?
Lyn M. dos Santos, MD
Pediatric Emergency Medicine
Children's Hospitals and Clinics
Maureen McCollough Hill wrote:
> Case for the group:
> 2 yr old child presents to ED after choking episode at home. Child was
> playing with beans from a daycare arts-and-crafts and suddenly choked. Mom
> sees child having trouble breathing and performs a Heimlich. Out pops a
> bean. Child still with stridor and wheezing. Mom brings kid to ED. In ED
> for 3 hrs. Still has "audible stridor and wheezing" during ED stay. Maybe
> improves with Albuterol, but not completely. Child maybe has a history of
> "asthma" prior to this choking episode. No prior admits for asthma. Child
> well prior to choking episode. Child admitted to peds floor for
> "observation" with albuterol. ED diagnosis on chart 1. Foreign body
> aspiration, 2. Bronchospasm
> No xrays, no bronchoscopy, just observation with albuterol.......Standard
> of care??
> Maureen McCollough
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