Research Day
THE IMPORTANCE OF PATIENT ADVOCACY IN FOREIGN BODY IDENTIFICATION AND MANAGEMENT: A CASE SERIES
Document Type
Abstract
Date
2021
Abstract
Introduction: Foreign bodies can present dilemmas for Emergency Department (ED) physicians given the challenges of obtaining reliable histories, dependence on plain radiographs, and a need to balance recommendations from subspecialty consultants.
Case 1: A 42-year-old male presented to the ED after aspirating a plastic caulk cap. Lung sounds on the right were diminished and chest x-ray revealed hyperinflation of the right lung. Pulmonology opined that this was related to inflammation given the lack of a radiopaque object, but after the ED physician reiterated his concerns, the consultant agreed the findings could be secondary to foreign body obstruction. During bronchoscopy, the cap was discovered blocking the right mainstem bronchus.
Case 2: A 22-year-old female presented to the ED with left-sided pharyngeal pain after ingesting the stem of her eyeglasses. X-rays revealed an 8-9cm linear object in the proximal esophagus, but no foreign body was found on esophagogastroduodenoscopy. Gastroenterology suggested the object had passed naturally; however, the patient was adamant it was still present. The ED physician reidentified the foreign object on bedside ultrasound, and computed tomography showed it had penetrated the esophagus and was resting anterior to the left carotid sheath.
Discussion: These cases demonstrate how advocacy for the patient, despite more conservative recommendations from consultants, is critical in ensuring appropriate final management. Placing more emphasis on the patient's history and the corroborating physical exam findings can lead to better management and outcomes for the patient while building trust between patients and providers.