Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Foreign Body Ingestion
Case Study
A rapid response event was initiated by the bedside nurse after the patient threatened to kill himself and swallowed a needle with no visualization in the oropharynx. Upon the prompt arrival of the rapid response team, it was noted that the patient was a 35-year-old male with a known history of prior severe suicidal ideation, bipolar disorder, alcohol use disorder, and recent imprisonment who was admitted earlier to the psychiatric ward because of suicidal plans and thoughts. The patient had attempted to swallow other foreign bodies in the past, and after one of the prior episodes, he had an endoscopy done for concerns of esophageal perforation.
Vital Signs
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Temperature: 98.2 °F, axillary
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Blood Pressure: 160/92 mmHg
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Pulse: 88 beats per min (bpm) – sinus rhythm on telemetry
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Respiratory Rate: 22 breaths per min
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Pulse Oximetry: 94% saturation on room air
Focused Physical Examination
A quick exam showed an anxious appearing young male in mild distress. Exam of the oropharynx showed erythema and hypersalivation. He had mild tenderness along the left submandibular area. No subcutaneous crepitus was palpated. No foreign objects were visualized in the oropharynx. Pulmonary, cardiac, and abdominal exams were unremarkable.
Interventions
A cardiac monitor and pads were attached. Airway, breathing, and circulation were assessed and secured. A stat chest X-ray was obtained at the bedside, which showed a metallic object in the esophagus. Stat consult was called to ear, nose, and throat (ENT) given submandibular tenderness and hypersalivation. Mild erythema was seen in the posterior oropharynx and laryngopharynx on flexible bedside laryngoscopy. No obvious evidence of perforation was seen. Once it was ensured that there was no airway compromise, a stat consult was called to gastroenterology, and the patient was transferred to the gastrointestinal (GI) lab for emergent endoscopy.
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