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I wonder what the "observation" is intended to accomplish. With the acute onset of both stridor and wheezing, the fact that the child was playing with beans (plural), and was previously well, the standard of care is obvious. I suppose one needs to get a chest X-ray just to rule out prior foreign body or get a hint as to where the foreign body is, but bronchoscopy and removal of the "beans" needs to be done before the inflammation which surrounds a long-term foreign body makes removal more difficult (and potentially more dangerous). 
My 2 cents.
Regards,


Allen R. Walker, MD
Pediatric Emergency Medicine
Johns Hopkins 
Baltimore, MD  USA
(410) 955-6143

>>> Maureen McCollough Hill <[log in to unmask]> 09/06/00 04:33AM >>>
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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