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Button Batteries: Part 2 - Getting Them Out

In my last post, I detailed how to suspect and image a button battery ingestion. In this one, I’ll describe how to extract them, and how quickly it’s necessary.

When batteries come to rest and are surrounded by moist mucosal tissue, a current arc is generated around the two sides of the button. This releases heat, which coagulates the surrounding tissue. Depending on the location, closeness of contact, and the duration, these burn injuries may extend into underlying tissue. This is of particular significance in the esophagus, which is in close proximity to the thoracic aorta.

Here’s a simple demonstration you can do at home with some lunch meat:

Here are guidelines for what to do when you encounter pediatric patients who have ingested a button battery:

  • If the child is experiencing bleeding from the upper GI tract, activate your trauma team. The child may have an aorto-esophageal fistula. If there is no active bleeding, obtain a chest x-ray to assess the battery’s position. If there is active bleeding, proceed to the OR (preferably a hybrid room if you have one) and use fluoro to locate the battery. If bleeding persists, call appropriate pediatric surgical specialists (surgery, CV surgery, GI), activate your massive transfusion protocol, and consider tamponade with a Blakemore tube (remember those?) or a urinary catheter if you don’t have one.
  • No bleeding from the upper GI tract? If the battery is large (>20mm) and/or the child is small (<5 years), and is lodged in the esophagus, proceed immediately to OR and remove endoscopically.
  • Batteries in the stomach are of less concern. They will generally pass if <20mm. A repeat x-ray after 48 hours should be obtained for larger batteries. If still in the stomach, they should be removed endoscopically. Smaller batteries will usually pass, and should be re-imaged after two weeks to confirm this.

References:

  • Button battery and magnet ingestions in the pediatric patient.  Curr Opin Pediatrics 30:653-659, 2018.
  • Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. J Pediatric Gastroenterol Nutr 60:562-574, 2015.
Source: https://thetraumapro.com/2019/04/09/button-batteries-part-2-getting-them-out/
Source: thetraumapro.com
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bookhobbit

Terry Pratchett: here’s this funny incompetent cowardly wizard who keeps getting into trouble, not much depth to his character b–

me: my son and also me, he’s acespec, he’s arospec, he’s bi, he’s trans, probably autistic, also those traits you meant to be funny? symptoms of mental illness, I have an intricate web of headcanons for his backstory and his future, my city now

poorlydescribedpterrybooks

“One of the traditions of the fantasy and science fiction genre is communication…Authors who write popular series find that readers are not passive receivers: they take the view that the author writes the script but the movie is played out in the reader’s own head, and therefore the enterprise is in some ways a collaboration or interactive one in which the reader has rights, if only the right to an opinion. This sort of thing has gone on for years in a private kind of way (“Dear Miss Austen, I think it would be really cool if one of your heroines were to fall in love with Napoleon…”). It’s probably healthy.”

~Terry Pratchett, “Wyrd Ideas”

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trek-tracks

Captain Christopher Pike: Starfleet… is a promise. I give my life for you; you give your life for me. And nobody gets left behind. And I’m sure Starfleet Command feels the same.

Starfleet Command Support Group For Self-Sacrificing Captains: 

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star trek star trek discovery star trek disco star trek dsc christopher pike captain pike star trek discovery spoilers discovery spoilers the simpsons i married marge so you've ruined your life through the valley of shadows this is a terrible post and i feel bad for making it this is making fun of starfleet support being terrible not captain pike or wheelchair users captain pike is a lovely human star trek tos
bmouse punishandenslavesuckers
idiopathicsmile

i’ve probably said this before but there is no purer love than enjoying a fanfic writer’s work so much that you start indiscriminately consuming every single thing they write, even in fandoms where you’ve never consumed the source material and in fact have zero interest in consuming the source material but great, now i’ve got all these orphaned feelings about characters i couldn’t pick out of a goddamn lineup

scrolling through ao3 like well shit, you magnificent and terrible wizard, what the fuck are you gonna make me care about next

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perhaps not more pure but equally pure is the love we writers feel when people leave comments saying the equivalent of “I don’t even go here but I’m reading this anyway because you wrote it”

gives me a dippy grin every time!

strawberryspacejam

@punishandenslavesuckers me with your content

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Bless you. ❤️

OH YEAH and sometimes you will just fall backwards...into robots
thatsbelievable

Anonymous asked:

How many people run this blog to make it constantly flow with creativity? I’m working on getting a communications degree and think this would be a fun thing to add to a resume even if it’s Payless!

Thanks for your question! If you look at the ABOUT US section of our site, you’ll see that it takes a team of experts, as well as an army of unpaid interns, to keep this site up to snuff.

(There’s also a rumor that it’s all the work of THIS ONE GUY. But you know how rumors go.)

Anyway. The important thing is, MAKE SOMETHING. It doesn’t have to be “perfect” — it just has to BE. (Trust us, we know all about that!) Have fun doing it, and if you create something, point us in the direction so we can see it!! Good luck, and thanks for reading That’s Believable!