Endoscopic Evaluation for Stricture Formation Post Button Battery Ingestion

Every year, there are over 3300 ingestions of button batteries, mostly by young children. Initial presentation of button battery ingestion may be nonspecific, with a delay in diagnosis and removal resulting in increased risk of complications. We present the case of a five-year-old female who presented with vomiting following unwitnessed button battery ingestion. The battery was impacted in the middle esophagus for at least six hours. Endoscopy was performed for immediate removal and showed a Grade 2B erosion, warranting nasogastric tube placement. The patient remained asymptomatic following discharge and had a barium swallow that was read as normal. However, a repeat endoscopy one month later visualized stricture formation at the previous battery injury site. This case highlights the importance of both clinician and parent awareness of button battery ingestion and demonstrates that endoscopy provides the most accurate assessment of esophageal injury and complication development, even in asymptomatic patients.

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The Use of Ultrasound in Nasogastric Tube Placement in Children Admitted to the Pediatric ICU

Case Medical Research ◽

10.31525/ct1-nct04104295 ◽

2019 ◽

Author(s):

Keyword(s):

Nasogastric Tube ◽

Tube Placement ◽

Nasogastric Tube Placement ◽

Pediatric Icu

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Myocardial Noncompaction

Revista de Chimie ◽

10.37358/rc.18.8.6500 ◽

2018 ◽

Vol 69 (8) ◽

pp. 2209-2212

Author(s):

Alexandru Radu Mihailovici ◽

Vlad Padureanu ◽

Carmen Valeria Albu ◽

Venera Cristina Dinescu ◽

Mihai Cristian Pirlog ◽

...

Keyword(s):

Ventricular Arrhythmias ◽

Specific Treatment ◽

Left Ventricular ◽

Left Ventricular Noncompaction ◽

Ventricular Noncompaction ◽

Genetic Transmission ◽

Asymptomatic Patients ◽

Increased Risk ◽

Patients With Heart Failure

Left ventricular noncompaction is a primary cardiomyopathy with genetic transmission in the vast majority of autosomal dominant cases. It is characterized by the presence of excessive myocardial trabecularities that generally affect the left ventricle. In diagnosing this condition, echocardiography is the gold standard, although this method involves an increased risk of overdiagnosis and underdiagnosis. There are also uncertain cases where echocardiography is inconclusive, a multimodal approach is needed, correlating echocardiographic results with those obtained by magnetic resonance imaging. The clinical picture may range from asymptomatic patients to patients with heart failure, supraventricular or ventricular arrhythmias, thromboembolic events and even sudden cardiac death. There is no specific treatment of left ventricular noncompaction, but the treatment is aimed at preventing and treating the complications of the disease. We will present the case of a young patient with left ventricular noncompactioncardiomyopathy and highlight the essential role of transthoracic echocardiography in diagnosing this rare heart disease.

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Acute Gastric Dilatation: A Cause for Concern

Case Reports in Gastroenterology ◽

10.1159/000512401 ◽

2021 ◽

pp. 171-177

Author(s):

Danial Haris Shaikh ◽

Abhilasha Jyala ◽

Shehriyar Mehershahi ◽

Chandni Sinha ◽

Sridhar Chilimuri

Keyword(s):

Nasogastric Tube ◽

Radiological Finding ◽

Plain Film ◽

Tube Placement ◽

Gastric Dilatation ◽

Acute Hyperglycemia ◽

Acute Gastric Dilatation ◽

Physician Awareness ◽

Gastric Emphysema ◽

Nasogastric Tube Placement

Acute gastric dilatation is the radiological finding of a massively enlarged stomach as seen on plain film X-ray or a computerized tomography scan of the abdomen. It is a rare entity with high mortality if not treated promptly and is often not reported due to a lack of physician awareness. It can occur due to both mechanical obstruction of the gastric outflow tract, or due to nonmechanical causes, such as eating disorders and gastroparesis. Acute hyperglycemia without diagnosed gastroparesis, such as in patients with diabetic ketoacidosis, may also predispose to acute gastric dilatation. Prompt placement of a nasogastric tube can help deter its serious complications of gastric emphysema, ischemia, and/or perforation. We present our experience of 2 patients who presented with severe hyperglycemia and were found to have acute gastric dilation on imaging. Only one of the patients was treated with nasogastric tube placement for decompression and eventually made a full recovery.

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Gastrostomy Tubes Placed in Children With Neurologic Impairment: Associated Morbidity and Mortality

Journal of Child Neurology ◽

10.1177/08830738211000179 ◽

2021 ◽

pp. 088307382110001

Author(s):

Jody L. Lin ◽

Joseph Rigdon ◽

Keith Van Haren ◽

MyMy Buu ◽

Olga Saynina ◽

...

Keyword(s):

Severe Pneumonia ◽

Sensitivity Analyses ◽

Tube Placement ◽

Composite Outcome ◽

Eligibility Criteria ◽

Risk Of Death ◽

Cox Proportional Hazard ◽

Neurologic Impairment ◽

Increased Risk ◽

The Impact

Background: Gastrostomy tube (G-tube) placement for children with neurologic impairment with dysphagia has been suggested for pneumonia prevention. However, prior studies demonstrated an association between G-tube placement and increased risk of pneumonia. We evaluate the association between timing of G-tube placement and death or severe pneumonia in children with neurologic impairment. Methods: We included all children enrolled in California Children’s Services between July 1, 2009, and June 30, 2014, with neurologic impairment and 1 pneumonia hospitalization. Prior to analysis, children with new G-tubes and those without were 1:2 propensity score matched on sociodemographics, medical complexity, and severity of index hospitalization. We used a time-varying Cox proportional hazard model for subsequent death or composite outcome of death or severe pneumonia to compare those with new G-tubes vs those without, adjusting for covariates described above. Results: A total of 2490 children met eligibility criteria, of whom 219 (9%) died and 789 (32%) had severe pneumonia. Compared to children without G-tubes, children with new G-tubes had decreased risk of death (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.39-0.55) but increased risk of the composite outcome (HR 1.21, CI 1.14-1.27). Sensitivity analyses using varied time criteria for definitions of G-tube and outcome found that more recent G-tube placement had greater associated risk reduction for death but increased risk of severe pneumonia. Conclusion: Recent G-tube placement is associated with reduced risk of death but increased risk of severe pneumonia. Decisions to place G-tubes for pulmonary indications in children with neurologic impairment should weigh the impact of severe pneumonia on quality of life.

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EFFECT OF NASOGASTRIC TUBE PLACEMENT AND MANIPULATION ON TRANSCUTANEOUS ULTRASONOGRAPHIC VISUALISATION AND ASSESSMENT OF STOMACH POSITION

Equine Veterinary Education ◽

10.1111/eve.34_13534 ◽

2021 ◽

Vol 33 (S12) ◽

pp. 21-22

Keyword(s):

Nasogastric Tube ◽

Tube Placement ◽

Nasogastric Tube Placement

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Clinical Stratification of Pregnant COVID-19 Patients based on Severity: A Single Academic Center Experience

American Journal of Perinatology ◽

10.1055/s-0041-1723761 ◽

2021 ◽

Vol 38 (05) ◽

pp. 515-522

Author(s):

Marissa Berry ◽

Amanda Wang ◽

Shannon M. Clark ◽

Hassan M. Harirah ◽

Sangeeta Jain ◽

...

Keyword(s):

Pregnant Women ◽

Disease Severity ◽

Gestational Age ◽

Laboratory Data ◽

Population Characteristics ◽

Neonatal Outcomes ◽

P Value ◽

Asymptomatic Patients ◽

Increased Risk ◽

Maternal And Neonatal Outcomes

Objective This study aimed to describe baseline characteristics of a cohort of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and determine if these correlate with disease severity and perinatal outcomes. Study Design This was a retrospective cohort trial conducted at the University of Texas Medical Branch Galveston, Texas. All pregnant women presented to our medical center, who were screened and tested positive for SARS-CoV-2 virus, were included. We stratified our study population in three groups: asymptomatic, symptomatic not requiring oxygen therapy, and patients requiring oxygen support to maintain oxygen saturation >94%. Relevant population characteristics, laboratory data, and maternal and neonatal outcomes were abstracted. A p-value <0.05 was considered statistically significant. Results Between March and July 2020, 91 women tested positive for SARS-CoV-2 upon admission to our labor and delivery unit. Among these, 61.5% were asymptomatic, 34.1% were symptomatic, and 4.4% required oxygen support. Our population was mainly Hispanic (80.2%), multiparous (76.9%), obese (70.3%), and with a median age of 27 years. Median gestational age at symptom onset or diagnosis was 36 weeks. Significant differences were found between gestational age and disease severity. Maternal characteristics including age, body mass index (BMI), and presence of comorbid conditions did not appear to influence severity of SARS-CoV-2 infection. Significant laboratory findings associated with increasing disease severity included decreasing hemoglobin and white blood cell count, lymphopenia, and increasing levels of inflammatory markers including CRP, ferritin, and procalcitonin. Maternal and neonatal outcomes did not differ among groups. No SARS-CoV-2 was detected by polymerase chain reaction testing in neonates of mothers with COVID-19. Conclusion Pregnant patients with COVID-19 infection are predominantly asymptomatic. Patients appear to be at increased risk for more severe infection requiring oxygen support later in pregnancy. Key Points

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Best Evidence: Nasogastric Tube Placement Verification

Journal of Pediatric Nursing ◽

10.1016/j.pedn.2011.04.030 ◽

2011 ◽

Vol 26 (4) ◽

pp. 373-376 ◽

Cited By ~ 20

Author(s):

M. Anne Longo

Keyword(s):

Nasogastric Tube ◽

Tube Placement ◽

Nasogastric Tube Placement

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Self – Assessment MCQ Questions for Vol.1 No.3

Acute Medicine Journal ◽

10.52964/amja.0030 ◽

2002 ◽

Vol 1 (3) ◽

Author(s):

D Phil ◽

DK Satchithananda ◽

David McNamara ◽

Joanna C Girling ◽

Marguerite E Hill ◽

...

Keyword(s):

Atrial Fibrillation ◽

Blood Pressure ◽

Pulmonary Embolism ◽

Sinus Thrombosis ◽

Accessory Pathway ◽

Foot Drop ◽

Ventricular Rate ◽

Repeat Endoscopy ◽

Increased Risk ◽

Bleeding Gastric Ulcer

(DK Satchithananda, A Macnab & AJF Page) · The following are true of atrial fibrillation: 1. An irregularly irregular pulse is pathognomonic of atrial fibrillation. 2. Co-ordinated atrial activity at around 300 beats per minute is usually apparent on the 12 lead ECG. 3. Ventricular rate is usually between 100-160 beats per minute in untreated AF. 4. Bradycardia usually implies the presence of an accessory pathway. 5. P-waves may be visible on the baseline of a 12-lead ECG. · The following are true of cardioversion for AF: 6. Following successful electrical cardioversion, more than 90% of patients remain in sinus rhythm at 1 year. 7. Anticoagulation prior to cardioversion is not mandatory if the duration of AF is less than 48 hours. 8. Biphasic energy defibrillation is associated with a higher success rate. 9. Sotalol is contraindicated for patients with ischaemic heart disease. 10. Flecainide is the pharmacological treatment of choice for patients with structurally normal hearts. (P Bhandari & P Patel) · The following are associated with a higher mortality following upper GI haemorrhage: 11. Older age. 12. Co-existent liver disease. 13. Reflux oesophagitis on endoscopy. 14. Systolic blood pressure >100mmHg on admission. 15. Pulse rate · Following the diagnosis of bleeding gastric ulcer: 16. Oral proton pump inhibitors reduce likelihood of rebleeding. 17. Intravenous ranitidine should be administered if peptic ulcer disease is identified on endoscopy. 18. Helicobacter pylori eradication may be beneficial. 19. Repeat endoscopy is not required. 20. Aspirin is less likely to cause recurrence if enteric-coated. (A J Lindahl, M E Hill & D Phil) · Which of the following are common clinical features of Myasthenia Gravis? 21. Unilateral foot drop. 22. Nasal regurgitation when swallowing liquids. 23. Fluctuating hemiparesis. 24. Headache. 25. Unilateral dilated unreactive pupil. · Which of the following statements about MG are true? 26. It is predominantly a disease of young women. 27. Removal of a thymoma may result in disease remission. 28. It is rare before puberty. 29. The elderly are less likely to respond to medication. 30. A negative anti-acetylcholine receptor antibody test does not rule out the diagnosis. · When treating MG: 31. It is generally safe to start steroid treatment as an outpatient. 32. Steroids should be introduced slowly. 33. Most myasthenics manage well on anticholinesterases and do not require immunosuppression. 34. Gastrointestinal side effects are common with anticholinerases. (J C Girling) · During pregnancy: 35. The ECG finding of an S wave in lead I, Q-wave in lead III and inverted T-wave in lead III usually implies pulmonary embolism. 36. PO2 is usually lower with the patient supine. 37. Increased risk of pulmonary embolism is confined to the 3rd trimester. 38. Low molecular weight heparin should be avoided. 39. D-dimer is usually positive. · Following a first fit during pregnancy: 40. The absence of proteinuria and normal blood pressure excludes the diagnosis of eclampsia. 41. Treatment with magnesium sulphate is recommended for eclampsia. 42. Cortical sinus thrombosis should be considered. 43. Sodium valproate is the drug of choice for non-eclamptic fits. 44. Amniotic fluid embolism should be considered. (D McNamara) · Neuroleptic Malignant Syndrome (N.M.S.) and Serotonin Syndrome (S.S.) have the following differences: 45. S.S. has a higher mortality. 46. N.M.S. has a quicker onset. 47. S.S. has a slower course. 48. S.S. has a higher recurrence rate following drug rechallenge. 49. Laboratory findings are more supportive diagnostically of N.M.S. · Strategies with proven efficacy include: 50. ECT for S.S. 51. Cyproheptadine for N.M.S. 52. Dantrolene for S.S. 53. Benzodiazepines for both. 54. Artificial ventilation for both. · Risk factors for N.M.S. include: 55. agitation. 56. rapid neuroleptisation. 57. previous ECT. 58. brain injury. 59. females.

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