Tasty Morsels of EM 092 – #FRCEM Croup and airway foreign bodies

29 Jul

I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.

You can find more things on the FRCEM on this site here.

Outline Croup and its management

  • parainfluenza (>80%)
  • 6 months to 5 years
  • Westley croup score components
    • Stridor 0-2
    • Retractions 0-3
    • Air entry 0-2
    • cyanosis 0, 4, 5
    • Level of consciousness 0, 5
  • Treatment
    • dex 0.15mg/kg
    • adrenaline neb 0.5mg/kg (max 5mg)

Describe some other stridorous infections

  • baterial tracheitis
  • diptheria
    • mainly an exotoxin disease
    • causes myocarditis too
    • airway obstruction due to pharangeal exudate (the pseudomembrane)

Creative commons via Dileepunnikri

  • treatment
    • usual airway stuff
    • antitoxin
    • IV erythromycin
  • epiglottitis
    • haemophilus influenza the main bug
    • everyone is immunised but immunity wanes so there’s lots of it in older folk
    • 2-7 the child age

Where do ingested foreign bodies lodge and how are they managed

  • swallowed coin
    • sticks at
      • C6, cricopharyngeus
      • T4, aortic arch
      • T10, gastroesophageal sphincter
    • on AP xray
      • round if in oesophagus
      • vertical line if in trachea
  • button batteries
    • everybody panic!!!
    • rapid oesophageal perforation (within hours)
    • can also cause septal perf if in the nose but slightly less drama needed
    • xray chest and belly
      • look for the “edge” to distinguish it from coin
    • once in the stomach there’s rarely issues
    • endoscopy rather than foley catheter the preferred method
  • magnets
    • concern seems to be with these small rare earth magnets (sold in packets of hundreds of them, they’re small round and shiny and kids eat them)
    • magnets on either side of a loop of bowel will attract each other causing a pressure necrosis and perf


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