foreign body (sensation) in throat, but no NP scope?

3 Sep

TRY THE GLIDE-SCOPE (or other video laryngoscopes)

recent post from The Procedural Pause covers the procedure for checking for and/or removing a fish bone using a Glidescope assist:

HIGHLIGHTS:

Anesthetize the throat (e.g. benzocaine spray, viscous lidocaine)

Feel, ask the patient to localize (if they can)

Take a look with the Glide-Scope (slowly)

Retrieve the foreign body with long hemostats/forceps (?suction)

Follow-up with ENT 24-48 hrs

Others have gone there before…

anesthesia article on 26 patients with impacted crycofaringeal upper esophageal FB, after unsuccessful removal attempts in the ENT or GI unit

  • under concious sedation, 17/26 foreign bodies identified & removed
  • the other 9/26 needed rigid endoscopy in general anesthesia/intubation, but had FBs impacted beyond the upper esophageal sphincter

cadaver study, with inexperienced 1st-year EM residents retrieving foreign bodies with Mac’s & Glide-Scopes

  • better 1st attempt removal with Mac’s
  • faster with Magill forceps (has a bend) than Sponge forceps (straight)
  • possible limitation: Glide-Scope’s bigger than the standard Mac, limited oropharynx space & maneuvering, especially for 1st years with little airway experience

BOTTOM LINE:

Working at a few hospitals lately without a readily available NP scope, which makes evaluation of a patient with a pharyngeal foreign body (sensation) more challenging.  

Many EDs now have a video laryngoscopes as an airway adjunct, and was wondering if that might be useful tool to look for a foreign body, in absence of an NP scope.  Nice to know some other folks have gone there before, with some success.

Along with DL visualization, add it (GlideScope/video visualization) to the toolbox.  

References: procedural pause post (picture’s from here); anesthesia article; cadaver article

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