11 year old female with history of developmental delay, non-verbal presenting for suspected FB ingestion. Per patient’s father, the patient became distressed in the late afternoon where she started grabbing his hand and putting it on her chest and throat while crying. Father reports patient then laid down and noticed her face turning red, while appearing to have difficulty breathing. Denies any drooling. EMS was called and on their arrival the patient had another episode of her face turning red and appearing as though she was having difficulty breathing. Of note, she has had a cough for the last week that is getting better now. She was also treated for otitis media 3 weeks ago. NKDA, IUTD. 

Vital Signs: Unable to obtain 

General:  Alert, difficult to examine d/t developmental delay.    

Skin:  Warm, dry, and intact.    

Head:  Normocephalic, atraumatic.    

Neck: unable to examine 

Eye: normal conjunctiva. no discharge.    

Ears, nose, mouth and throat:  Oral mucosa moist  

Cardiovascular: Normal peripheral perfusion.    

Gastrointestinal: unable to examine 

Back:  Normal range of motion  

Musculoskeletal:  Moves all extremities  

Neurological: Alert. No focal neurological deficit observed.  

IMAGE from OSH (below)

CXR concerning for pneumomediastinum and subcutaneous emphysema in the neck and supraclavicular area. No FB appreciated.  XR abdomen showed no FB, only stool burden.  

GI was consulted and recommended surgical evaluation to determine if the patient needed surgical intervention as perforation is a contraindication for scoping a patient.  

Reexamine patient: 

Neck: Supple.  crepitus on palpation of neck and supraclavicular area bilaterally.    

Gastrointestinal: Soft.  Non distended.  tenderness to palpation of epigastric area. 

Respiratory: Lungs are clear to auscultation. Respirations are non-labored. Breath sounds are equal.    

Cardiac: RRR, no murmur