{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 31, Ep 3 of 4: Foreign Body and Caustic Ingestion","html":"","width":"100%","height":180,"duration":789,"description":"Episode three works two mechanical emergencies that each hand you a recognition cue and a defined intervention with a clock embedded in it. For foreign bodies the urgency of removal follows the mechanism of injury, not the politeness of the object, sorting into three timing tiers from two-hour disc batteries to blunt objects that never come out. The food bolus doubles as the eosinophilic esophagitis biopsy opportunity that closes if you do not take it at the same procedure. For caustic ingestion, substance category drives the injury pattern, the airway is the first priority, and the Zargar grade at endoscopy drives short-term feeding and monitoring while late stricture and squamous cell carcinoma risk drive long-term surveillance.\n \nTopics covered\n\nUrgency follows mechanism, not the object\nThree timing tiers for removal\nDisc batteries, sharps, and magnets\nDrug packers versus stuffers\nFood bolus and the eosinophilic esophagitis gateway\nAlkali versus acid injury patterns\nAirway priority and contraindicated interventions\nZargar grading and feeding safety\nLate strictures and cancer surveillance\n \nKey decisions\n\nRemove an esophageal disc battery within two hours because hydroxide drives alkaline liquefactive necrosis within two hours and can perforate, and remove esophageal obstruction with unmanageable secretions or a sharp esophageal object within six hours.\nRemove food bolus without complete obstruction, non-sharp esophageal objects, gastric or duodenal sharps, objects longer than six centimeters, and reachable high-power magnets within twenty-four hours, while managing blunt asymptomatic post-duodenal objects expectantly.\nDo not endoscope body packers or stuffers because rupture during retrieval risks a fatal toxic dose, reserving laparotomy for symptoms of leak.\nTake at least four biopsies from proximal and distal esophagus at the same procedure when no eosinophilic esophagitis diagnosis exists, since roughly half of adult food bolus impactions trace to it and...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}