For this 18-month-old girl, a trip to the playground led to a bloody diaper and a trip to the ED. Do you detect foul play?
Foreign Body? Jet the Other Nostril
No one works very long in an emergency department without running into a child with a foreign body up the nose. Sometimes things go well in your attempts at retrieval. Other times…
Anyway, here’s a trick to think about the next time you have a neurologically normal child, older than 6 months, with, say, a bead up the nose. Have the child sit up with the arms restrained.
Take a bulb syringe filled with about 7 ml of sterile saline and gently advance it up the opposite nostril until you get a good seal. Give a firm, forceful squeeze. The foreign body should come shooting out the other side.
Caveats: wear protective gear, as things can get a little messy when they come shooting out at you. Also proceed with confidence but with the strict understanding that you are only going to get one shot at this.
For the academically inclined, this technique is described in Lichenstein R, Giudice EL. Nasal wash technique for nasal foreign body removal. Pediatr Emerg Care 2000;16:59-60. Read more