Fishbone in Throat (ER)

“You like fish?” Dr. Mike Ziegler jokes. “You
like it so much you ate it bones and all?” Six-year-old Angeliq
nods with a smile. While eating dinner, she accidentally swallowed
a fish bone. “And it feels like it’s still there?” he
asks. She nods again.

An initial exam and x-ray show no sign of the bone, but as Dr.
Ziegler explains, “it’s possible that it could also
be obstructed by some other structure, so I’m just gonna
take a little bit closer look.”

But that’s easier said than done.

“Now, I’m gonna use this,” the doctor says
putting a tongue depressor in Angeliq’s mouth. But, Angeliq
won’t allow it. She starts to gag.

Since that doesn’t work, the doctor tries a numbing spray. “You
have to stick your tongue out and say ahhh for me,” he says
attempting to spray the back of her throat. She gags again.

The time has come for extra measures. “I also administered
some Versed, which is a sedative like Valium to try to see if we
could relax her, take away some of her anxiety and maybe get a
little better look into her throat,” explains the doctor.

After twenty minutes, to allow the sedative to kick in, they
try again. “Open up like we practiced,” says Angeliq’s
mom. Even more relaxed, Angeliq gags again. Nothing works.

The time has come for a decision, put her under heavy sedation,
which is risky, or send her home in hopes that the bone is gone.

“I think we’re gonna stop,” Ziegler says, “because
I think it’s, I think putting her under heavy sedation for
this is probably a little more than I think is reasonable at the
point.”

He explains further, “If you give a patient medication
which by their nature suppress your drive to breath or suppress
your ability to protect your own airway and then you go mucking
around in the airway, the risk of doing something like that escalates
significantly.”

So, they send her home. She’ll have to come back if she has
a fever, trouble swallowing, or increased pain. But two days later,
a quick phone call to the family reveals, “so she never developed
any other symptoms and the ones that she did have just went away.” Angeliq
is just fine.

Oftentimes, children swallow things – such as fish bones – that
clear up on their own. However, more than 2,800 people die each year
from choking, and many of them are children. According to one study,
nearly two-thirds of the children who choked to death during a 20-year
period were 3 years old or younger. Another study found that nearly
70 percent of choking deaths among children ages 3 and under were caused
by toys and other products made for children, and yet another found
that nearly 70 percent of choking cases presented in the emergency
department were caused by foods such as hotdogs, nuts, or vegetable
and fruit pieces. The one constant found through all the research and
studies is that if a child can put something in his/her mouth, he/she
can choke on it.

According to the American Academy of Pediatrics (AAP), the following
items are common choking hazards:

• Hot dogs and sausages
• Chunks of meat
• Grapes
• Hard candy
• Popcorn
• Peanuts and other nuts
• Raw carrots
• Fruit seeds
• Apple chunks
• Coins
• Toys with small parts
• Small balls and marbles
• Balloons
• Arts and crafts materials
• Ballpoint pen caps
• Watch batteries
• Jewelry

The AAP says children are likely to choke on small, round, pliable objects
that conform to the shape of the airway.

Anything that fits in your child’s
mouth can be a choking hazard. Food, toys and other small objects that
can easily lodge in a child’s small airway usually cause choking.
Experts at the American Medical Association encourage parents to pay
special attention to the following to prevent your child or baby from
choking:

Food

• Don’t give a child under age four any hard, smooth foods that
  can partially or completely block the windpipe. These include nuts
  of any type, sunflower seeds, watermelons with seeds, cherries
  with pits, raw carrots, raw peas, raw celery, popcorn and hard
  candy.
• Some soft foods can also cause choking because they are the
  right shapes for blocking a child’s windpipe. These foods, including
  hot dogs, sausages, grapes and caramels, can be served if they
  are chopped into small pieces. Spoonfuls of peanut butter and chewing
  gum should also be regarded as potential choking hazards.
• When babies begin eating solids, beware of foods like raw apples
  and pears, which may be difficult to chew without teeth (or with
  just a few teeth).
• Encourage children to sit when eating and to chew thoroughly.
  Teach them to chew and swallow their food before talking or laughing.
• Never let children run, play sports or ride in the car with
  gum, candy or lollipops in their mouths.
• Be especially vigilant during adult parties, when nuts and other
  foods might be easily accessible to small hands. Clean up early
  and carefully, and check the floor for dropped foods that can cause
  choking.

Toys

• Always follow all manufacturers’ age recommendations when buying
  toys. Some toys have small parts that can cause choking, so heed
  all warnings on a toy’s packaging.
• Never buy vending-machine toys for small children; these toys
  do not have to meet safety regulations and often contain small
  parts.
• Check toys frequently for loose or broken parts – for
  example, a stuffed animal’s loose eye or a broken plastic hinge.
• Warn older children not to leave loose game parts or toys with
  small pieces in easy reach of younger siblings.

Balloons and other small objects

• Never give balloons to a child younger than age eight. A child
  who is blowing up or chewing on a balloon can choke by inhaling
  it. Inflated balloons pose a risk because they can pop without
  warning and be inhaled.
• Safely dispose of button-cell batteries.
• Encourage children not to put pencils, crayons or erasers in
  their mouths when coloring or drawing.
• Don’t reward small children with coins.

If you’re a parent, grandparent or other caregiver, learn
how to help a choking child and how to perform CPR in case of an
emergency. Choking prevents oxygen from getting to the lungs and
the brain, and when the brain goes without oxygen for more than four
minutes, brain damage or even death may occur. According to the AAP,
you should start first aid if …

• The child cannot breathe at all (the chest is not moving up
  and down).
• The child s airway is so blocked that there is only a weak cough
  and a loss of color.
• The child cannot cough, talk or make a normal
  voice sound.
• The child is found unconscious. (Go to CPR.)

DO NOT start first aid if …

• The child can breathe, cry, talk or make a normal voice sound.
• The child has a strong cough. (A strong cough means there is
  little or no blockage.)