Foreign Boby
Foreign Boby
Foreign Boby
• Final Diagnosis –
foreign body aspiration (areca nut)
s/p bronchoscopy – removal
Hypoxic seizure
Anemia not in failure
Presenting complaints
Cough x 15 days
Fast breathing x 10days
Up rolling of eyes/stiffening of b/l Upper limb and lower limb x 3
episode
Urinary retention x 1 week
History of presenting complaints
Cough and cough X since 15 days
• Wet sounding
• Mainly during night, no postural variation
IMMUNIZATION HISTORY –
Till 9 months
PAST HISTORY –
At 3 months of age- cold and cough x 2 days, received nebulization
At 6 months of age – cold, cough, fever x 2days, nebulization for 3 days
FAMILY HISTORY –
No h/o seizure in the family
A- IRRITABLE
B- INCREASED WORK OF BREATHING
C- PALE
A- Maintainable
B- RR- 30/min, Spo2- 96% in RA, ICR/SCR, Added sounds present
C- HR-132bpm, BP- 111/60, PP- wellfelt, Peripheries – warm, CFT- <3
sec, Urine output- Normal
D- GCS-15, E4 M6 V5, Pupils 2mm, equal and reactive, No
seizures/posturing
E- Temp- 98.6F
WORKING DIAGNOSIS-
1. Bronchopneumonia with anemia(not in failure, ? nutritional) and
hepatomegaly
2. Bronchopneumonia to r/o foreign body aspiration with ?apnoeic spell /
seizures
ABG
• pH- 7.36
• pO2- 44.1mmHg
• NA+/K+/Cl- 144/3.9/113
• Ca2+ - 4.66
• Lac – 9
• HCO3 – 24.2
• Anion gap – 6.2
• CO2- 57.2
• pO2- 84.4
29/5/22 4.57pm
Treatment given in ER
• Neb. 3%NaCl 3ml
• O2 @5L/min via face mask
• Inj. Ceftriaxone 580 mg iv
• IVF ½ DNS @45ml/hr +1cc KCl/100ml IVF
25/5/22 2.71
27/5/22 3
29/5/22 6.60/28.8 13.93 2.22 48/46 145/2.53/99
SJMCH 3.47
143/3.20/98
29/5/22 (6pm ) Inj. Lorazepam
On examination - Inj. Hydrocortisone
drowsy IVF ½ DNS
HR-141bpm Neb. 3%NaCl
BP – 122/82 mm of Hg Neb. Salbutamol
RR- 27/min Neb. Ipravent
Chest examination – O2 @5L/min via Face mask
• stridor present, 1unit PRBC
• expiratory wheeze, Inj. KCl 3cc 30ml over 1 hour under cardiac
• b/l wheeze supraclavicular and monitering
suprasternal retractions
Hb- 6.60
Pottasium- 2.53 meq/dl
TREATMENT RECEIVED
Inj. Ceftriaxone
30/5/2022 (8am) TREATMENT RECEIVED
HR-142 /min Inj. Ceftriaxone
RR – 32/min Inj. Hydrocortisone
BP - 126/81 mm of Hg Inj. Fosphenytoin
SpO2- 97% in RA, Inj. KCl
RDS-4/10 IVF ½ DNS
RS- ICR +, crepitations +,stridor+ O2 @5L/min via face mask
prolonged expiration Neb. Ipravent
Issues Saline nebulization Q6hrly
1 Respiratory distress
2. Nutrition – IVF full maintenance
3. Hypolakemia
4. Seziure
30/5/2022 (10 am )
HR- 160/min
RR- 30/min
BP- 100/60
SpO2 – 98%
B/L conducted sound, sternal and suprasternal retractions.
Plan :
To plan for Bronchoscopy with PESU
Stop salbutamol and Ipratropium
• 1 episode of hypoxic seizure GTCS lasting for 15 sec – loaded with leviteracetam,
11. midazolam.
30a • I/v/o desaturation – intubated and connected to mechanical ventilation
m
• – As child was being shifted to OT on portable ventilator child was noticed to have
tachycardia, HR-149/min, SpO2 – 40%.
I/v/o bradycardia with desaturation , reassessed the child HR-50/min, inadequate chest
12.00 pm rise,
• CPR done 1 dose of adrenaline given, HR 100/min, SpO2 85%.
• Child was reintubated with 5 cuffed tube SpO2 – 75%continued on bag ventilation,
• Chest Xray s/o Collapse
2.0 • shifted to OT
0
pm
Bronchoscopy
Anaesthesia given at 3.30 end time 4.10
Operative procedure- bronchoscopy with foreign body retrieval
Foreign body (a piece of areca nut ) impacted in the right primary
bronchus removed in toto, mucosa inflamed, secretions +
Post Op events - Mechanical ventilation continued for 48 hours,
i/v/o hypotensive episode – fluid resuscitation , low dose ionotrope
adrenaline for 24hrs continued.
Piperacillin tazobactum is added, oseltamivir stopped. Dexa continued
for 72hrs
31/5/22 5.38pm 1/7/22 5.50am
3/5/22 5.57am
Day 5 (3/6/22) child was extubated to HFNC. NG feeds started.
DISCHARGE ADVICE
Inj. Pipercacillin tazobactum 1.2gm iv Q8hrly
Syp.Levetiracetam 1.2ml -0-1.2ml
Tab. Lanzoprazole 10mg OD
To continue HFNC for further 24 hrs