Nasal CE Protocol ©

Pediatric Emergencies

Action Algorithm

1
Discard Button Cell !!
If suspected: Immediate Rx and refer to ENT.
2
Analgesia and Sedation
Local oxymetazoline + Intranasal sedation if there is no collaboration.
3
Extraction Techniques
1. Positive Pressure (Mother Kiss)
Procedure: Occlude the healthy nostril. The caregiver seals his or her mouth over the child's open mouth and gives a short, forceful breath.
Indication: Ideal for smooth objects that occlude almost all light. Closes the glottis and expels the CE.
2. Foley catheter (5-6 Fr)
Procedure: Introduce deflated exceeding the CE. Inflate the balloon (1-2 ml of air/serum) and gently pull outwards.
Indication: Spherical or smooth objects (marbles, beads). It is contraindicated to use tweezers on round objects due to the risk of pushing them!
3. Hook/Curette
Procedure: Slide the instrument flat against the septum, exceeding the CE. Rotate 90º to embrace the back of the object and pull.
Indication: Irregular objects or objects with edges that do not fall apart when dragged.

Intranasal Sedation

Recommended dosage: 0.3mg/kg (Midazolam 5mg/ml)

Dose: 0.00 ml

* Maximum 1 ml per nostril. Use atomizing device (MAD).
Mandatory SpO2 monitoring.

Ready Material

Light source (front best)
MAD Device (Atomizer)
6Fr Foley Catheter / Katzen Catheter
Powerful magnet (if CE metallic)
Suction material

Refer to ENT

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