By Dr. Kala Frye Bourque, Children’s National Medical Center

HPI: A healthy 18-month-old male presents with his mother and grandmother. About 30 minutes PTA patient was playing in mother’s bedroom while she was doing laundry. Mother heard gagging and looked down to find patient with metal hanger in his mouth. Mother pulled hanger from mouth and noticed bleeding immediately. Bleeding has since stopped but he is fussy and drooling somewhat.

Exam:

Vitals: T 36.5C, HR 120, RR 26, Sat 99% on RA

General – Playful, running around triage room, apprehensive when placed on exam table

HEENT – Cry is appropriate. Some blood-tinged saliva in mouth. No laceration to buccal mucosa or tongue. Possible injury to left tonsillar pillar with no active bleeding.

Resp – CTA. Equal.

CV – Tachycardic (during exam only due to crying). No murmurs. Peripheral pulses 2+.

You decide to get an X-ray of the chest and neck which are read as “Normal radiologic study of the upper airway and chest.” Patient is starting to drift off to sleep (it is now late in the evening) and mother and grandmother are worried that he is possibly snoring louder than usual. He continues to have no drooling or bleeding. On exam he has no retractions or suprasternal tugging. Snoring is only intermittent with no stridor in between. No tachypnea or pauses noted.

Out of an abundance of caution you discuss the case with ENT. On their exam, they see no active bleeding and he is swallowing his own secretions. They have no further recommendations currently. He has been on a monitor and saturating in the 90’s while sleeping.

You discuss plan with mother and grandmother who are happy to take him home as he is currently drinking apple juice and eating goldfish.