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Paeds Vivasacute-care-resuscitation-and-toxicology

Paeds Vivas · acute-care-resuscitation-and-toxicology

Button-battery and magnet ingestion — branching viva

A branching viva following one child with a suspected button-battery ingestion from the doorway through airway security, the localising radiograph and the halo sign, the two-hour endoscopic removal target, the honey adjunct and its limits, the multiple-magnet counterpoint, and the delayed aorto-oesophageal-fistula teaching point, with safeguarding and prevention throughout.

branching clinical structured oral6 min readVerification in progress

Target exams

RACP General PaediatricsRACP DCERCPCH Progress+MRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics
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Target exams

RACP General PaediatricsRACP DCERCPCH Progress+MRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics
Prompt
A four-year-old is brought to a rural emergency department drooling after playing with a remote control that is now missing a battery. The examiner releases information in stages. The candidate must secure the airway and breathing, take the focused history and the localising radiograph, recognise the halo sign and the two-hour endoscopic removal target, give the honey adjunct in the eligible child while mobilising removal, manage the multiple-magnet counterpoint, anticipate the delayed aorto-oesophageal fistula, and run safeguarding and prevention in parallel.

Branching cross-examination

This is a MedVellum formative viva. It is not an official RACP, MRCPCH, ABP, ACGME or RCPSC station, mark scheme, duration or pass standard. Release each update only after the candidate states the failing system, the immediate action and the reassessment endpoint. [1] [2]

Candidate brief

You are the senior paediatric clinician in a rural district emergency department. Speak as you would during resuscitation. Secure immediate threats before the diagnosis is certain, state the change you expect from each action, and say what you will reassess. This is one continuous case. Each escalation branch leads to the next update. [2]

Paediatrics Fellowship Pro

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You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship library.

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References8ShowHide
  1. [1]Mubarak A, Benninga MA, Broekaert I, et al. Diagnosis, Management, and Prevention of Button Battery Ingestion in Childhood: A European Society for Paediatric Gastroenterology Hepatology and Nutrition Position Paper Journal of pediatric gastroenterology and nutrition, 2021.PMID 33555169
  2. [2]Kramer RE, Lerner DG, Lin T, et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee Journal of pediatric gastroenterology and nutrition, 2015.PMID 25611037
  3. [5]Goh S, Siu JM, Philteos J, et al. Pediatric Esophageal Button Battery Protocol Reduces Time From Presentation to Removal The Laryngoscope, 2024.PMID 38934450
  4. [6]Schmidt YM, Muensterer O, Wendling-Keim D The use of honey in button battery ingestions: a systematic review Frontiers in pediatrics, 2023.PMID 37842023
  5. [7]Chiew AL, Lin CS, Nguyen DT, et al. Home Therapies to Neutralize Button Battery Injury in a Porcine Esophageal Model Annals of emergency medicine, 2024.PMID 37725021
  6. [8]Eck JB, Ames WA Anesthetic Implications of Button Battery Ingestion in Children Anesthesiology, 2020.PMID 32011339
  7. [9]Altokhais T Magnet Ingestion in Children Management Guidelines and Prevention Frontiers in pediatrics, 2021.PMID 34422734
  8. [12]Han Y, Youn JK, Oh C, et al. Ingestion of multiple magnets in children Journal of pediatric surgery, 2020.PMID 31937446
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