Our surgeons use the folly catheter technique ( they are also the ones doing
Laparoscopic appendectomies and delayed appies on perforated aps.)
They have nearly 100% retrieval rate .. failure usually if the coins have
been in >2 days.. Of course if the coin in below the middle third they just
giving ice chips and following up in 24 hours, providing patient in not
having symptoms ..
Our group of PEM docs are not using the technique, but then the pediatric
surgical fellows are on cal to us 24 hours/dayX 7 days/week.
I fear that one day they will tear an esophagus by trying to get out an
embedded coin, but if they do, they are certainly the one's to repair the
problem..On the other hand if I removed the coin an tore the esophagus, I
could only holler for help. a situation that I would rather avoid..
Now I have read ( PEM care?)that a group in Texas is using bouginage to
advance all esophageal foreign bodies into the stomach, Actually with very
favorable results. I think this technique would actually be better because
it would avoid the feared esophageal tears.and be less traumatic for the
As for surgical cricothyrotomies.. I have not heard of anyone doing one on a
child less than 8. Personally I have tried on a 6 year old who had a
suspected cspine injury and was having mouth bleeding, but was not
successful ( pediatric surgical fellow was with me and neither one of us
could find the airway). Eventually the senior fellow did get an endotracheal
tube in,but even this proved to be a futile effort as the child had was
later shown to have sustained massive head injuries that were not going to
be amenable to treatment. These injuries did prove fatal in a matter of a
few hours. .Personally, I have encountered very few kids under 8 that are
candidates for this radical airway technique and think that when faced next
time, might go to retrograde intubation before cutting the neck..In adults I
have been able perform this same maneuver on four occasions without a hitch.
Thus demonstrating to me that the pediatric airway is different and that the
same technique used in adult airways may not be as easy or possible to do in
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