PMID- 21324294
OWN - NLM
STAT- MEDLINE
DCOM- 20110616
LR  - 20191027
IS  - 1481-8043 (Electronic)
IS  - 1481-8035 (Linking)
VI  - 13
IP  - 1
DP  - 2011 Jan
TI  - Esophageal coin removal by emergency physicians: a continuous quality improvement 
      project incorporating rapid sequence intubation.
PG  - 28-33
AB  - OBJECTIVE: The objective of this study was to describe our experience removing 
      esophageal coins from children in a tertiary care pediatric emergency department 
      over a 4-year period. METHODS: We retrospectively reviewed a continuous quality 
      improvement data set spanning October 1, 2004, through September 30, 2008. 
      RESULTS: In 96 of 101 cases (95%), emergency physicians successfully retrieved 
      the coin. The median age of the children was 19 months (interquartile range [IQR] 
      13-43 months; range 4 months-12.8 years). The median time to removal of coin from 
      initiation of intubation was 8 minutes (IQR 4-14 minutes; range 1-60 minutes). 
      Coins were extracted using forceps only in 56 cases, whereas forceps and a Foley 
      catheter were used in the remainder. Succinylcholine and etomidate were used in 
      almost all cases for rapid sequence intubation prior to coin removal. 
      Complications were identified in 46 cases: minor bleeding (13), lip laceration 
      (7), multiple attempts (5), hypoxia (3), accidental extubation (3), dental 
      injuries (3), bradycardia (2), coin advanced (1), right main-stem bronchus 
      intubation (1), and other (8). CONCLUSIONS: Emergency physicians successfully 
      removed esophageal coins following rapid sequence intubation in most cases. Our 
      approach may be considered for the management of pediatric esophageal coins, 
      particularly in an academic pediatric emergency department.
FAU - Bhargava, Rishi
AU  - Bhargava R
AD  - Loma Linda Medical University Medical Center and Children's Hospital, Loma Linda, 
      CA 92354, USA. rishbhar@yahoo.com
FAU - Brown, Lance
AU  - Brown L
LA  - eng
PT  - Journal Article
PL  - England
TA  - CJEM
JT  - CJEM
JID - 100893237
SB  - IM
MH  - Child
MH  - Child, Preschool
MH  - Emergency Medicine/*methods
MH  - Esophagus/*injuries
MH  - Female
MH  - Foreign Bodies/*surgery
MH  - Humans
MH  - Infant
MH  - Intubation/*methods
MH  - Male
MH  - *Numismatics
MH  - Quality Improvement
MH  - Retrospective Studies
MH  - Time Factors
EDAT- 2011/02/18 06:00
MHDA- 2011/06/17 06:00
CRDT- 2011/02/18 06:00
PHST- 2011/02/18 06:00 [entrez]
PHST- 2011/02/18 06:00 [pubmed]
PHST- 2011/06/17 06:00 [medline]
AID - 10.2310/8000.2011.100298 [doi]
PST - ppublish
SO  - CJEM. 2011 Jan;13(1):28-33. doi: 10.2310/8000.2011.100298.