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I've had a few of similar cases and have found the value of 'shopping around' for specialists.  I.e. I
try ENT first (but some don't feel comfortable with kids), then peds pulmonary (all of whom do
bronchoscopy here) and once I had luck with pediatric surgery - they do rigid bronchoscopy under GET.
Anyway - there's always another consultant if you don't like the first answer...

Virgil Davis.


Lyn dos Santos wrote:

> Maureen:
> 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
> Minneapolis, MN
>
> 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
> >
> > For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> > The URL for the PED-EM-L Web Page is:
> >   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
>
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html