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A 49-year-old clinically intoxicated male patient presented to the emergency department (ED) after suffering an assault. Upon initial presentation, he was noted to have a complex upper lip laceration and significant jaw pain suspicious for mandible fracture. During the course of his evaluation, the patient suddenly leapt from the bed and assaulted a medic. He was restrained by multiple security and medical staff with difficulty and given intramuscular haloperidol and ativan for pharmacologic restraint. As he was placed back on the bed, he was noted to be apneic and pulseless. Chest compressions and mask ventilation were initiated, an intraosseous line was placed, and one milligram of epinephrine was administered. On direct laryngoscopy, part of a foreign body was seen coiled around the epiglottis. The complete foreign body was manually removed (image), a 7.5 mm endotracheal tube was placed, and there was prompt return of sinus rhythm and pulses.
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