Resident Manual of Trauma to the Face, Head and Neck

reason, rigid endoscopy is still recommended in pediatric patients for aspirated and ingested foreign bodies. b. Flexible Endoscopy Advances in flexible endoscopy with improved instrumentation have allowed for comparable foreign body retrieval and may be considered in adults or patients who are not ideal candidates for general anesthesia. Flexible endoscopy may be used for removal of blunt objects or meat impaction, but is not recommended for sharp objects due to inability to sheath the object and protect the mucosa on retrieval. Gastric foreign bodies are most successfully removed with flexible endoscopes. 4. Postoperative Management a. Monitoring Patients, particularly children, should be monitored for approximately 4 hours for fever, tachycardia, or tachypnea. b. Airway Edema If airway edema is noted during the case, consider racemic epinephrine with or without steroids. c. Reflux Precautions and Medical Therapy Reflux precautions and medical therapy are prescribed, depending on the extent of mucosal injury from esophageal foreign bodies. d. Perforation or Heightened Symptoms If a perforation is suspected or symptoms worsen, obtain a chest x-ray immediately postoperatively (see II.D.2.b, Computed Tomography). F. Prevention and Management of Complications 1. Indications for Antibiotics Consider using antibiotics for the following conditions: y y Aspirated vegetable matter or retained foreign bodies with thick mucoid secretions. y y Esophageal perforation, mediastinitis, or abscess formation. y y Patients with underlying pulmonary issues or poor lung compliance. Broad-spectrum antibiotic selection should include coverage for gram- negative bacilli and methicillin-resistant Staphylococcus aureus. Anaerobe coverage should be considered for patients with significant periodontal disease, alcoholism, or foul smelling sputum. Antibiotic coverage may be adjusted based on culture results and continued for 7 days.

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