Emergency Medicine Jobs and Esophageal Coin Removal
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Joy Cutler
May 16, 2013, 2:24:04 PM5/16/13
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Please consider this free-reprint article written by:
Joy Cutler
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Article Title: Emergency Medicine Jobs and Esophageal Coin Removal
Author: Joy Cutler
Word Count: 759
Article URL: http://www.isnare.com/?aid=1840054&ca=Jobs
Format: 64cpl
Contact The Author: http://www.isnare.com/eta.php?aid=1840054
Easy Publish Tool: http://www.isnare.com/html.php?aid=1840054
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Emergency room physicians are accustomed to treating many types of illnesses, accidents, and other ailments for patients of all ages. Pediatric patients can be some of the most challenging in the emergency department, partly due to the types of mischief they may get themselves into, and partly due to their decreased ability to communicate clearly about what is ailing them. Children are also prone to curiosity, which often leads to accidental poising, choking, and similar events. Sometimes, accidental ingestion of objects like marbles, keys, or coins can be handled quickly if the parent sees the object and removes it quickly from the child�s mouth. However, in cases where the object is swallowed completely, life-threatening complications can result.
A group of emergency room physicians at a hospital in California saw so many cases of accidental coin ingestion that they developed a special team of ER physicians to handle the events. While most parents know that children enjoy chewing on or attempting to eat small objects, they may not realize that coin ingestion in particular is extremely common. If a coin is swallowed, it most often passes through the entire digestive tract and passes out of the body harmlessly. However, at other times, the coin can become trapped in the esophagus, leading to throat irritation, gagging, or vomiting. In the most severe cases, a coin can cause esophageal perforation, migration (i.e. movement into other areas), or a tracheoesophageal fistula (an abnormal connection between the esophagus and the trachea). Some cases are fatal to their victims.
At the hospital discussed here, emergency room physicians had typically passed cases of coin swallowing to pediatric surgeons, pediatric gastroenterologists, or otolaryngologists at their institution, rather than handling the surgical removal themselves. However, in 2004, the hospital decided to train its emergency room doctors to perform the procedure(s) themselves in order to make care faster and more efficient. The physicians and hospital then documented the success of this strategy over the following years. The patients included in the study were those younger than 18 years who had ingested a coin within the preceding 72 hours; in most cases, the coins were located in the upper third of the esophagus. The emergency room physicians who performed removal on these patients followed established guidelines, such as using rapid sequence intubation (RSI) followed by direct visualization of the esophagus with a laryngoscope. In cases where the coin was visible, the physician would then remove it using Magill forceps (a type which are curved to allow better access to the esophagus). In cases where the coin was not visible, a Foley catheter was passed beyond the coin, its balloon inflated, and then the catheter was withdrawn.
In addition to the data about the outcomes of the procedures they performed, the physicians also noted statistics on which types of coins were most likely to be swallowed, and general descriptive statistics about patients. For instance, most of the patients were male, and their average age was 19 months (with an age range of 4 months to 12.8 years!) The most commonly swallowed coins were pennies, followed by quarters, and then nickels. On average, it took about 8 minutes to remove the coin from each patient; in cases where the physicians could not locate the coin visually beforehand, it took about 12 minutes to remove. Most patients had only very mild complaints following their treatment, such as sore throat, dental pain, or a mild cough.
Overall, the decision to train emergency physicians to perform esophageal removal of coins was viewed as a success. In the 101 cases that were included in the study, the procedure was successfully carried out 95% of the time. The authors note that while they made sincere efforts to follow up with the families of children who had undergone the procedure, not all families participated in the follow up questionnaire or interview portion of the study, meaning any complications they may have suffered were not recorded. Furthermore, any children with resulting complications from the procedure that were treated elsewhere were not reported, again potentially limiting the data for this part of the study. Despite these minor facts, the study was successful and the hospital where it was carried out plans to continue using emergency room physicians for pediatric coin removal cases. This particular study along with the training it described are good examples of how emergency medicine jobs may involve more than just routine care for heart attack victims or severely injured patients. Often, these doctors may encounter extraordinary and unusual situations, and must respond quickly and effectively.
About The Author: Learn more about http://www.physemp.com/physician_jobs/perma_emergency_jobs.html emergency medicine jobs at Physicians Employment. See over 200 specialties, including http://www.physemp.com/physician_jobs/perma_pediatrics_jobs.html pediatrics jobs, hospitalist jobs, and more.
Please use the HTML version of this article at:
http://www.isnare.com/html.php?aid=1840054
*********************** ARTICLE END ***********************
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Message delivered directly to members of the group:
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*****************************************************************
Please consider this free-reprint article written by:
Joy Cutler
*****************************
IMPORTANT - Publication/Reprint Terms
- You have permission to publish this article electronically in free-only publications such as a website or an ezine as long as the bylines are included.
- You are not allowed to use this article for commercial purposes. The article should only be reprinted in a publicly accessible website and not in a members-only commercial site.
- You are not allowed to post/reprint this article in any sites/publications that contains or supports hate, violence, porn and warez or any indecent and illegal sites/publications.
- You are not allowed to use this article in UCE (Unsolicited Commercial Email) or SPAM. This article MUST be distributed in an opt-in email list only.
- If you distribute this article in an ezine or newsletter, we ask that you send a copy of the newsletter or ezine that contains the article to http://www.isnare.com/eta.php?aid=1840054
- If you post this article in a website/forum/blog, ALL links MUST be set to hyperlinks and we ask that you send a copy of the URL where the article is posted to http://www.isnare.com/eta.php?aid=1840054
- We request that you ask permission from the author if you want to publish this article in print.
The role of iSnare.com is only to distribute this article as part of its Article Distribution feature ( http://www.isnare.com/distribution.php ). iSnare.com does NOT own this article, please respect the author's copyright and this publication/reprint terms. If you do not agree to any of these terms, please do not reprint or publish this article.
*****************************
Article Title: Emergency Medicine Jobs and Esophageal Coin Removal
Author: Joy Cutler
Word Count: 759
Article URL: http://www.isnare.com/?aid=1840054&ca=Jobs
Format: 64cpl
Contact The Author: http://www.isnare.com/eta.php?aid=1840054
Easy Publish Tool: http://www.isnare.com/html.php?aid=1840054
*********************** ARTICLE START ***********************
Emergency room physicians are accustomed to treating many types of illnesses, accidents, and other ailments for patients of all ages. Pediatric patients can be some of the most challenging in the emergency department, partly due to the types of mischief they may get themselves into, and partly due to their decreased ability to communicate clearly about what is ailing them. Children are also prone to curiosity, which often leads to accidental poising, choking, and similar events. Sometimes, accidental ingestion of objects like marbles, keys, or coins can be handled quickly if the parent sees the object and removes it quickly from the child�s mouth. However, in cases where the object is swallowed completely, life-threatening complications can result.
A group of emergency room physicians at a hospital in California saw so many cases of accidental coin ingestion that they developed a special team of ER physicians to handle the events. While most parents know that children enjoy chewing on or attempting to eat small objects, they may not realize that coin ingestion in particular is extremely common. If a coin is swallowed, it most often passes through the entire digestive tract and passes out of the body harmlessly. However, at other times, the coin can become trapped in the esophagus, leading to throat irritation, gagging, or vomiting. In the most severe cases, a coin can cause esophageal perforation, migration (i.e. movement into other areas), or a tracheoesophageal fistula (an abnormal connection between the esophagus and the trachea). Some cases are fatal to their victims.
At the hospital discussed here, emergency room physicians had typically passed cases of coin swallowing to pediatric surgeons, pediatric gastroenterologists, or otolaryngologists at their institution, rather than handling the surgical removal themselves. However, in 2004, the hospital decided to train its emergency room doctors to perform the procedure(s) themselves in order to make care faster and more efficient. The physicians and hospital then documented the success of this strategy over the following years. The patients included in the study were those younger than 18 years who had ingested a coin within the preceding 72 hours; in most cases, the coins were located in the upper third of the esophagus. The emergency room physicians who performed removal on these patients followed established guidelines, such as using rapid sequence intubation (RSI) followed by direct visualization of the esophagus with a laryngoscope. In cases where the coin was visible, the physician would then remove it using Magill forceps (a type which are curved to allow better access to the esophagus). In cases where the coin was not visible, a Foley catheter was passed beyond the coin, its balloon inflated, and then the catheter was withdrawn.
In addition to the data about the outcomes of the procedures they performed, the physicians also noted statistics on which types of coins were most likely to be swallowed, and general descriptive statistics about patients. For instance, most of the patients were male, and their average age was 19 months (with an age range of 4 months to 12.8 years!) The most commonly swallowed coins were pennies, followed by quarters, and then nickels. On average, it took about 8 minutes to remove the coin from each patient; in cases where the physicians could not locate the coin visually beforehand, it took about 12 minutes to remove. Most patients had only very mild complaints following their treatment, such as sore throat, dental pain, or a mild cough.
Overall, the decision to train emergency physicians to perform esophageal removal of coins was viewed as a success. In the 101 cases that were included in the study, the procedure was successfully carried out 95% of the time. The authors note that while they made sincere efforts to follow up with the families of children who had undergone the procedure, not all families participated in the follow up questionnaire or interview portion of the study, meaning any complications they may have suffered were not recorded. Furthermore, any children with resulting complications from the procedure that were treated elsewhere were not reported, again potentially limiting the data for this part of the study. Despite these minor facts, the study was successful and the hospital where it was carried out plans to continue using emergency room physicians for pediatric coin removal cases. This particular study along with the training it described are good examples of how emergency medicine jobs may involve more than just routine care for heart attack victims or severely injured patients. Often, these doctors may encounter extraordinary and unusual situations, and must respond quickly and effectively.
About The Author: Learn more about http://www.physemp.com/physician_jobs/perma_emergency_jobs.html emergency medicine jobs at Physicians Employment. See over 200 specialties, including http://www.physemp.com/physician_jobs/perma_pediatrics_jobs.html pediatrics jobs, hospitalist jobs, and more.
Please use the HTML version of this article at:
http://www.isnare.com/html.php?aid=1840054
*********************** ARTICLE END ***********************
- To distribute your articles go to http://www.isnare.com/distribution.php
- For more free-reprint articles go to http://www.isnare.com
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