Nasal foreign body and button-battery injury — formative SAQs

SAQ 1 — The two-year-old with a missing button battery (10 marks, 15 minutes)

A two-year-old boy is brought to the emergency department after his parents found the back of a remote control open and a button battery missing. He is well and afebrile, but on anterior rhinoscopy a shiny metallic disc is wedged firmly against the right side of the nasal septum. He last ate 30 minutes ago. ^[3]

a) State the immediate management decision and explain why the fasting status does not change it. (2 marks) ^{[3] [5]}

b) Explain the mechanism by which a button battery injures the nasal septum, naming the pole at which the key reaction occurs and the type of necrosis that results. (3 marks) ^{[5] [6]}

c) Describe how you would distinguish a button battery from a coin if the object were uncertain, naming the imaging sign. (2 marks) ^[9]

d) State what you would do immediately after the battery is removed, including two complications that can continue to evolve, and the role of a topical neutralising agent. (3 marks) ^{[3] [7]}