Mike, its The Ionising Radiation regulations 2000. Your Radiation Supervisor
is Linda Whitehead- but I think she's off on maternity. I'm not sure who is
deputising for her in that capacity ( several people are covering for her!).
Karen Prothero should be able to help.
Vikki Chase
Diagnostic Radiographer
( locum very occasionally at Airedale!)
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Michael Dudley
Sent: 17 April 2002 20:30
To: [log in to unmask]
Subject: Re: Swallowed FB was: Being over-riden by radiographers
Sorry, but what is "IRMER"?
Mike Dudley
Airedale
----- Original Message -----
From: Tom Beattie <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, April 17, 2002 7:11 PM
Subject: Re: Swallowed FB was: Being over-riden by radiographers
1. Area of great contention with reported practice often based on
prejudice and anecdote. 2 fbs lodged in stomach wall does tend to colour
views.
2. parents often difficult to pacify if fb not demonstrated. Not good
reason but me telling a parent who has waited 3 hours to be seen that no
xray indicated now but will see in a few days if fb not passed is a
different animal to a first year sho in the same situation. IRMER very
useful tool as allows sho to say fb xray not indicated. Consultant must
be prepared to back up sho
3. ideally no xray done on first visit but planned review at 5-10 days
gives reassurance to parent. If fb not seen in stool over 5-10
days(seldom seen as sieving stools unpleasant and I know only of a few
parents who have complied so not part of acvice; also kids often pooh
outside home at nursery etc where it will never be seen) xray in
screening room to demonstrate presence or absence of fb in stomach.
Screening can include chest/neck if concern.
4. Have metal detector but we must have got the "Monday morning" one as
it is hopelessly inaccurate. Gave up as very inaccurate.
5. having seen what our dog eats and passes I am confident that most fbs
will pass but have seen enough delay in transit eg fb in stomach @ 10-14
days to xray radio-opaque fbs. No logic here as non-opaque fbs are
ignored(includes glass which can be difficult to detect against bowel
shadow)
6. in the end I like to know what I am treating. We are fully signed up
to IRMER and have full radiologist support for our xray policy. I will
use this thread as reminder to audit fb xrays as what I say mightnt
always happen!!!!!!!!!!
PS in response to other thread I do not agree with your policy on
wrists/forearms/elbows. We have a sufficiently high pick-up rate on
elbow fracture presenting with wrist pain and vice versa to image
wrist/forearm/elbow on same film. Radiologists insist as protocol for
radiographers for all <10s as keeps radiation dose low and diagnostic
quality adequate in this age group
Sorry cant be more specific
Tom
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Adrian Fogarty
Sent: 17 April 2002 00:35
To: [log in to unmask]
Subject: Re: Swallowed FB was: Being over-riden by radiographers
But with your experience in paeds A&E Tom, that suggests a complication
rate
of way under 1%! What's your view on managing these cases anyway?
Regards
Adrian Fogarty
----- Original Message -----
From: Tom Beattie <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, April 16, 2002 9:46 PM
Subject: Re: Swallowed FB was: Being over-riden by radiographers
Yes. On 2 occasions over 15 years I have seen £1 coin lodged in stomach.
On each occasion endoscopy failed to dislodge and facilitate removal.
Coin almost through to peritoneum requiring surgical excision and repair
of damaged stomach wall on each occasion. Never with lesser value coin
though!.
Tom Beattie
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Helen Deborah Vecht
Sent: 15 April 2002 22:46
To: [log in to unmask]
Subject: Re: Swallowed FB was: Being over-riden by radiographers
The message <[log in to unmask]>
from [log in to unmask] contains these words:
> MDC:In 95% of cases the FB is passed uneventfully, but there
> is still a 5% of cases in which it that will be retained.
> A FB retained in the bowel can cause Obstruction, Perforation
> (followed by localized abscess, fistulization or generalized
> peritonitis) and Bleeding. It is indeed distasteful to look
> through the faeces <rest snipped>
Is the incidence of complications *really* that high? Let's see...
Can _anyone_ in this list ever seeing recall a *major* complication from
a swallowed coin that has passed below the diaphragm?
--
Helen D. Vecht: [log in to unmask]
Edgware.
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