I know what you are saying. Button batteries? Trauma? Not too many adult trauma professionals have seen or heard of this. But those who care for pediatric patients should be very familiar. If the importance of this seemingly minor problem is ignored, the results can be catastrophic.
Kids eat stuff, and not just food. The smaller ones always seem to be putting things in their mouths. Foreign body ingestion (or insertion into other orifices) is a common presentation at pediatric emergency departments. Unfortunately, the fact that a battery has been eaten may not be appreciated by the parents. The child may be brought in with nonspecific GI or respiratory symptoms.
As soon as a battery ingestion is known or suspected, a two-view chest x-ray is needed. This should show both chest and upper abdomen in order to visualize both esophagus and stomach. Separate chest and abdominal images may be required if the child is too large for a single shot. Two views (AP and lateral) are important because the nature of the foreign body may not be appreciated if the battery is seen edge-on.
If you are fortunate enough to image the battery “face-on”, you may see a telltale halo sign. Because of the way these batteries are put together, there are two metal sides that have a slight difference in overlap.
You’ve made the diagnosis! So now what? And how quickly? I’ll deal with this in my next post.
For most places, including Minnesota, hypothermia time is just about over! However, this trauma problem can occur nearly anywhere and at any time. And especially during a massive resuscitation. The optimal way to warm paitients has been debated for years. A number of very interesting techniques have been devised. Ever wonder how fast / effective they are?
I’ve culled data from a number of sources, and here is a summary what I found. And of course, the disclaimer: “your results may vary.”
|Rate of Rewarming
|Passive external (blankets, lights)
|0.5° C / hr
|Active external (lights, hot water bottle)
|1 – 3° C / hr
|Bair Hugger (a 3M product, made in Minnesota of course!)
|2.4° C / hr
|Hot inspired air in ET tube
|1° C / hr
|2 – 3° C / hr
|GI tract irrigation (stomach or colon, 40° C fluid, instill for 10 minutes, then evacuate)
|1.5 -3° C / hr
|Peritoneal lavage (instill for 20-30 minutes)
|1 – 3° C / hr
|Thoracic lavage (2 chest tubes, continuous flow)
|3° C / hr
|Continuous veno-venous rewarming
|3° C / hr
|Continuous arterio-venous rewarming
|4.5° C / hr
|Mediastinal lavage (thoracotomy)
|8° C / hr
|9° C / hr
|Warm water immersion (Hubbard or therapy tank)
|20° C / hr
The next issue of Trauma MedEd will be sent out to subscribers at the end of the week, and will cover a whole bunch of what I call Potpourri. These are some tidbits that I find fascinating and sometimes odd.
Topics will include:
- Trauma and the gut microbiome
- “Single look trauma laparotomy” (as opposed to damage control laparotomy) and postop complications
- Pneumothorax: how big is too big?
- The best prehospital stretchers for rapid extraction in MCIs
- and more!
I’ve pushed the solid organ injury update issue out to next month. There’s a lot of stuff to cover, and quite a few changes have occurred over the years.
As always, this month’s issue will go to all of my subscribers first. If you are not yet one of them, click this link right away to sign up now and/or download back issues.
Unfortunately, non-subscribers will have to wait until I release the issue on this blog, in mid-April. So sign up now!